Forms
Health history - please complete and bring with you to your appointment.
Consent for treatment - this will be filled out at your appointment.
Photography consent - this will be filled out at your appointment.
Payment and Appointment Time Understanding - this will be filled out at your appointment.
Aftercare instructions - you will be provided these at your appointment
Payment receipt for your health insurance company for POSSIBLE reimbursement for Breast Cancer Reconstruction tattoos ONLY. Permanent makeup and areola cosmetic tattooing are not covered by insurance.
Breast Cancer Reconstruction patients PLEASE READ THIS ENTIRE PAGE!
The Women’s Health and Cancer Rights Act of 1998 requires insurance to cover postmastectomy reconstruction, including areola/nipple tattooing. Insurance may reimburse some of the cost of procedures. We can provide you with a receipt to turn into your insurance provider for POSSIBLE reimbursement. You must turn the receipt in with a prescription from your physician’s office for the tattoo including medically appropriate diagnosis & CPT codes on the Rx itself. It is suggested that you check with your provider prior to your procedure to be sure this service is covered.
Here is a link to the US Department of Labor’s details on insurance coverage for women post breast cancer. http://www.dol.gov/ebsa/Publications/whcra.html
Insurance...the ugly truth
Unfortunately, insurance covers tattoos done in physician offices by unskilled staff with terrible results. UGLY results. They are billed astronomically to your insurance and every repeated application is as well. It's not unheard of to repeat this 3 or even 4 times in the doctor's office. I know, because I did exactly that for almost a decade in a plastic surgery office. This is not something I am proud of, knowing what I know now. It's highly likely these visits won't occur in your reconstructive year so this high amount hits your deductable/coinsurance. Many times these ladies pay way more when this process has occurred than an out of pocket payment for service to a specialized artist…and leave the doctor's office with a less than desirable result. About 25% of my clients require corrective tattooing for specifically this reason. Please see “corrective tattooing” in the gallery for examples.
I do suggest at least trying for reimbursement ...
I will provide you with my personal NPI, RN license, and tax EIN numbers plus the ICD10 and CPT codes your insurance company will require. I can give you these beforehand, so you can call your insurance company on your own behalf to see if this will be covered.
At minimum, they usually require the following turned in for reimbursement:
1. A prescription from your doctor with ICD10 and CPT codes-from you
2. A claim reimbursement form found on their specific website- from you
3. Receipt of payment which is paid to me on day of service-from you
4. Letter of medical necessity (which I can provide)- from me
5. My procedure note documentation- from me
6. Your health history form filled out at your visit- from me
7. * If they require a prior authorization- I do not do them (unless you are an OhioHealth employee or covered dependant). You may try to do it yourself but you will need the codes on your prescription from your doctor to provide to the insurance company. (see #1)
Pricing & Scheduling
Pricing includes consultation & procedure: IMPORTANT, PLEASE READ THE FOLLOWING: Payment due in full (by cash or card) on 1st appointment, nothing owed at 2nd visit. If you intend on using an FSA/HSA method of payment, bring a back up form of payment as well, in case I am not recognized as a health care service provider to that specific company. I can give you reimbursement forms to turn in to them. The 2nd visit must be completed within 12 months of the 1st application of color to be included in price bundle. This is typically done within 10 weeks of 1st visit but I will accomodate schedules to fit your needs as best I can (especially for those who travel for appointments). If any additional visits are deemed necessary at completion of 2nd appointment, they will be done at either no fee or a reduced fee per tattoo artist’s discretion, and completed within the 1st year. ***Moving forward with touch ups following the 1st 12 months… if additional color is desired after one years time, the charge rate is to pay 1/3 cost of the original price paid.
I cannot stress this part enough….
Please bring a prescription/clearance from your physician to your appointment, and any reimbursement forms required by your insurance company/H.S.A account to be filled out. I can provide you with paperwork to turn in for POSSIBLE insurance reimbursement. I NEVER guarantee your insurance company will reimburse you or to what amount. I am NOT a participating provider with ANY insurance company so, I'm considered out of network. I also do NOT do any prior authorizations with insurance because I am not a participating provider with any insurance company. **** Starting in 2021**** I will fill out OhioHealthy (ONLY) prior authorization forms and fax them in for approval. The appointment must take place at the Bing or Dublin Cancer Centers. The approval is good for 30 days from the date set for your appointment….if it expires due to rescheduling on YOUR PART, I WILL NOT BE ABLE TO CALL THEM FOR EXTENTIONS.
It is YOUR responsibility to call and find out what they require for your plan. After your tattoo, I am happy to send in my procedure documentation and a letter written on your behalf to your insurance company if requested, to aid in your reimbursement.
Consultations
I do not tattoo people I have not spoken to first.
I offer 3 types of consultations: phone with pictures, zoom, or in person.
Contact Christina by phone 937-470-5332 or a detailed email explanation (including call back number) can be sent to (livingstorytattoo@gmail.com) to request scheduling a consultation.
After the consultation, I schedule all appointments personally and do my best to accomodate people’s schedules. Once on the books, I have reserved a spot dedicated all to you.
*Note- I do not take security deposits or booking fees ahead of time, so please respectfully keep that in mind in the event that you are unable to keep your scheduled appointment. I book out months in advance and do not have walk-in business. My clients need suffient notice to move up into a cancelation slot for time off work, travel arrangements and childcare purposes. I understand life happens with work & kids, flu, Covid and other illnesses, car trouble, inclement weather and so on. I ask only that you do the courtesy of notifying me as soon as possible because late cancelations and no shows are very detrimental to a small business/self employed artist. ***NOTE: If a late cancelation or no show occurs, in order to rebook a new time slot, you may be notified to expect a rebooking fee (per artist discretion) added to the cost of your procedure and agree to pay the total amount in full on the day of your 1st visit.
Pricing
*Prices have increased as of 1/1/23*
If you scheduled an appointment for the current year backin 2022, and need to reschedule, I will honor the original price quoted if the reschedule date is made promptly and attended. Otherwise, any future appointments made at a later time are subject to new pricing. Thank you.
Nipple and Areola Reconstruction – In cases where a patient’s nipple-areola complex was entirely removed by either mastectomy or a surgical complication. The nipple-areola complex is COMPLETELY absent here. Can be 3D on flat skin, or over surgically performed nipple reconstruction (for nipple-sparing mastectomies, please see areola re-pigmentation pricing). ***Price includes two visits done 10 weeks apart (see paragraph under “Pricing & Scheduling” header for full details).
Unilateral reconstruction breast (one side tattooed only) $450
Note: If you start out doing just the reconstructed side and return later for the other breast- 2nd appointment costs start at $250 and up. If it is suggested during consultation, to do the native breast as well on the 1st visit to match- costs start at $700 and up. *Final cost is quoted per individual case, based on size of areola, scar/tissue damage present and time estimated to be required for the native areola work.
Bilateral reconstruction $700
Corrective - If you had previous undesirable tattooing elsewhere that needs fixed, or a “touch-up” on previous work done elsewhere. See above pricing with possible additional costs. Additional costs are due to: fixing of poor placement, cover-up of retained/faded cosmetic pigment, working on scar tissue caused by previous technician. Many times this is completed in two visits. However, additional sessions may be required. Prices quoted individually. ***If I personally tattooed you previously when I was a nurse at OSU plastic surgery and you are interested in a more realistic, long lasting tattoo, I'll be happy to offer a discount to you (quoted individually).***Price includes two visits done 10 weeks apart (see paragraph under “Pricing & Scheduling” header for full details).
Unilateral correction starting at $450
Bilateral correction starting at $700
Areola Re-pigmentation – after a breast surgery: nipple-sparing mastectomy, breast reductions or mastopexy, to even out color and shape, restore a lost nipple to surgery complication or injury, vitiligo located on the nipple-areola complex (M.D. clearance note required), or to simply darken your natural areolas. Normally this is done to both breasts to ensure symmetry. (Artist will determine cases where only one areola needs to be tattooed.) The price is quoted individually and based on size of areola, difficulty of work, amount of scar tissue/tissue damage present, expert techniques utilized (involving glandular and scar tissue), and time estimated to be required. Numbing creams are used for your comfort. Insurance does not cover this procedure for cosmetic purposes, it has to be deemed medically nessesary by them to cover. ***Price includes two visits done 10 weeks apart (see paragraph under “Pricing & Scheduling” header for full details).
Unilateral areola starting at $450
Bilateral areola starting at $700
Breast decorative (hearts, flowers, pink ribbons) - these are never covered by insurance. Prices are quoted individually by the piece. Requires in person consultation first. ***Price includes two visits done 10 weeks apart (see paragraph under “Pricing & Scheduling” header for full details).
Umbilical Restoration - done four to six months, or longer after tummy tuck, DIEP flap, or hernia repair operations. Prices quoted per individual case depending on scar tissue, size, and level of difficulty of the procedure. Price includes two visits done six weeks apart.
Prices start at $200 and up
Penile Reconstruction/Phalloplasty - After flap-creation of penis (cancer reconstruction or bottom surgery) or partial reconstruction of penis due to cancer. Typically done one year after reconstructive surgery. Color is built upon and details and realism added. Must be completely healed and free of infection. This procedure requires a minimum of 2 visits done 10 weeks apart (3 visits can be necessary). M.D. clearance note required. Price includes two visits. Any additional sessions will be quoted a reduced fee. *Price includes two visits done 10 weeks apart (see paragraph under “Pricing & Scheduling” header for full details).
Prices start at $1000 which includes first two visits
If three visits are required, prices quoted per individual
Syndactyly of Toes Correction- this is present from birth. The tattoo creates the illusion of space between the fused digits. *Price includes two visits done 10 weeks apart (see paragraph under “Pricing & Scheduling” header for full details).
Prices quoted individually.
Fingernail/Toenail Restoration- done to create the illusion of the nail appearance when absent. Many times due to a traumatic accident or could be present from birth. *Price includes two visits done 10 weeks apart (see paragraph under “Pricing & Scheduling” header for full details).
Prices quoted individually.
Cash or credit payment is accepted.
*Price are bundled and payment is due on 1st visit (see paragraph under “Pricing & Scheduling” header for full details).
Charity Options
Option 1: CAPS FOR THE CURE: These funds are made possible due to the generousity of the CAPS FOUNDATION. Donated money is raised at the CAPS for the Cure events by Columbus Aesthetic and Plastic Surgery. This service makes such a difference in the lives of survivors and thanks to the doctors at CAPS, women can feel whole again, regardless of where their reconstruction took place.
** If you’re interested in donating outside of a planned CAPS event please call 614-246-6900 or visit
Option 2:OHIO HEALTH FOUNDATION: Ohio Health Breast Cancer patients, if you have financial concerns regarding payment for your nipple tattooing please let me know. If you have had surgery/ treatment related to breast cancer at an Ohio Health facility, you may be eligible for financial assistance through the foundation at Ohio Health. After receiving approval, your tattoo must be done by me at the Bing Cancer Center or the Dublin Cancer Center. I'm very happy to be a part of the Ohio Health family and to participate in the foundation as a provider!
**If you would like to make a donation to this fund yourself, please click the link below & choose “Integrative Care Fund” as the designation. In the additional info/comment section please state you wish your donation to be applied to fund nipple areola tattooing with Living Story Tattoo, The Nipple Fairy. Thank you kindly for helping others by paying it forward. Your gift truly is life changing. Thank you so much.
https://foundation.ohiohealth.com/bing/cancer-services-giving
Option 3: I also am a participating provider in the AiRS FOUNDATION. Please visit the following link to their website in order to apply for assisted nipple tattoo funding through the AiRS FOUNDATION.
http://airsfoundation.org/apply-for-grant/
Click and scroll to find me here: https://airsfoundation.org/about/medical-advisory-board/
If you feel inclined to give please choose to click the clink below.
To round up a credit card change:
https://airsfoundation.harnessapp.com/wv2/donate?selected-method=roundup
For a one time donation:
https://airsfoundation.harnessapp.com/wv2/donate?selected-method=one-time
*** If you are receiving a breast tattoo for a restorative purpose such as, post-mastectomy nipple tattooing please bring a physician prescription/ referral/ note of clearance. Only nipple tattooing for this purpose is considered medical and not cosmetic. Any other form of decorative breast tattooing or cosmetic/ elective tattooing of the nipples is not deemed medically necessary by insurance.