Insurance Accepted at Vitruvian Surgical Institute

Dr. Carpenter is a participating medicare provider. Patients are responsible for their usual copayments, unless covered by a supplemental insurance policy. If your secondary insurance policy is medicaid, you are not responsible for the copays typically covered by medicaid.

As a participating Medicare provider, Dr. Carpenter accepts payments from Medicare Advantage Plans, although she is not specifically contracted with any Medicare Advantage Plan. Therefore, if your MAP is a PPO, your responsibility will be based on your insurance plan for out of network medicare providers. If your MAP is an HMO, our team will need to go through additional steps to get pre-authorization from either your primary care physician or insurance plan to ensure your care is covered with Dr. Carpenter. Please ensure you have the appropriate referrals, if needed, prior to your appointment.

Dr. Carpenter is an out-of-network provider for commercial insurance plans. If your plan is a PPO, your financial responsibility will be based on your insurance plan’s guidelines for out-of-network providers. If your plan is an HMO or EPO, our team will work with you through the additional steps needed to obtain pre-authorization from your primary care physician or insurance plan to help ensure your care with Dr. Carpenter is covered. For electively scheduled cases, our team will review Dr. Carpenter’s fee schedule with you in advance. Payment is collected ahead of surgery, and your claim is then submitted to your insurance by our billing department. Each insurance carrier has a specific allowed amount for a given procedure; after your insurance has processed and paid for the surgery, any reimbursement will be promptly refunded to you. Please note that your insurance carrier’s allowed amount may not always cover the full extent of Dr. Carpenter’s fees. Our team is happy to discuss any questions you may have about your estimated out-of-pocket costs.

If Dr. Carpenter is an out-of-network (non-participating) provider with your health insurance plan, if you have an HMO without out-of-network benefits, or if you have a PPO with high out-of-network deductibles and copayments, you may be eligible to request a gap exception from your insurance carrier. This can often help make your procedure more affordable by allowing more insurance coverage. A gap exception (also called a clinical gap exception, out-of-network exception, or network insufficiency exception) is a request your insurance company can approve on a case-by-case basis. It allows them to treat Dr. Carpenter’s services as if she were in-network when they do not have adequate in-network providers available to meet your specific needs. If approved, your insurance would cover their typical allowed amount for a given procedure, and that insurance payment would be refunded to you, so you ultimately would only be responsible for any difference between that allowed amount and Dr. Carpenter's standard surgical fees.

Insurance carriers are required by law to maintain adequate networks under the Health Benefit Plan Network Access and Adequacy Act. This means that if there is no in-network plastic surgeon who can perform the specific reconstructive care you need within a reasonable travel distance, wait time, or timeframe, your care may qualify for this exception. The procedure must also be medically necessary and already a covered benefit under your plan. Common situations where gap exceptions are granted include: 

1. The provider is the only specialist in the area performing a complex or rare procedure. 
2. The procedure is being performed at a hospital or surgery center where no in-network physicians have privileges. 
3. The in-network options provided by the insurance company may not have the specialized skills, experience, or availability that best meets your needs.

Dr. Carpenter’s team is here to support you through this entire process. While you will need to initiate the request with your insurance carrier, our office and billing department will assist you every step of the way by providing all necessary clinical documentation, procedure codes, and other required information. We’re happy to guide you and make the process as straightforward as possible. During the gap exception process, your insurance provider may ask you to:
• Confirm that the procedure is a covered benefit under your plan
• Obtain a referral from your primary care provider (if needed)
• Obtain pre-certification or prior authorization for the procedure
• Review the list of in-network providers to confirm that no other qualified plastic surgeon is available within a reasonable distance or timeframe, or has privileges at your chosen facility 

Please know that while we will do everything we can to help, there is no guarantee that your insurance carrier will approve the gap exception. Even if approved, it may not cover the full amount of Dr. Carpenter’s fees. Our team is always available to discuss your estimated out-of-pocket costs and answer any questions you may have. 

To help you get started, here is the information you will need: 

Provider name – Haley Carpenter, MD PhD
NPI – 1740766641
Office address – 2855 N University Drive, Suite 400, Coral Springs, FL 33065
Tax ID / TIN – 99-2188017
Office fax – 954-344-3781
Office phone – 954-344-4344
ICD-10 diagnosis code – ***
Procedure code(s) – ***
Expected date range of procedure – ***
Insurance plan name – ***
Patient member ID/Policy # – ***
Patient phone number – ***
Insurance reference number (provided by your carrier once the process begins) – *** 

How to begin:
Simply call your insurance carrier and request a gap exception for your planned procedure with Dr. Haley Carpenter. Provide them with the information above and any documentation they require. Be sure to ask for a reference or case number so you (and our team) can easily track your request. If you have any questions or would like our team to review your information before you call, please don’t hesitate to reach out. We’re here to help make this as smooth and stress-free as possible for you.