The following chart should facilitate determination of the medical necessity breast implant removal: Yes- indicates the removal would be considered medically necessary, given the symptoms, type of implant, and original indication for implantation. q/J endstream endobj startxref (Use the measurement key below) Our AskBlueSMFEP Medical Plan Finder tool can help you select the right option for your needs. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. Other insurance types such as disability insurance, motor vehicle insurance, prescription card plans and workers' compensation. However many plastic surgeons offer payment options and outside financing, the most popular being CareCredit. Chin augmentation (reshaping or enhancing the size of the chin) %8eRq xq{2cQ'YzRh(KE&WNO-ID.}16m', ~D[+d\q~0}h(U~LG 1ek[FZOvM) .P=xgu`E)I M p_]pV#g$ RkPGV9& G{(TRp. And if youre not sure just call us. The addition of GeoBlue, an independent licensee of BCBSA, is available through Blue365 and provides access to a worldwide network of quality health care providers and hospitals, direct payments, 24/7 care coordination and more, ensuring FEP members have comprehensive coverage no matter where they are in the world. Dear Geneseo,Thank you for your post. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. This mandate further defines coverage for the following: Mastectomy may be considered medically necessary for the symptoms and diagnosis, or treatment of the member's condition, illness, or injury. Your member ID card is your key to using your medical plan benefits. Nipple tattooing will be covered if the medical necessity criteria for reconstructive breast surgery are met. Complications of breast implants are common and may require removal of the implant. With enhanced benefits in all products in 2022, FEP continues its mission to provide unparalleled products and services to our members and their families.. We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele1-800-472-2689 TTY: 711). New Supplemental International Travel Insurance Services, drugs, or supplies billed by Preferred and Member facilities for inpatient care related to specific medical errors and hospital-acquired conditions known as Never Events (see definition on page. endstream endobj 1071 0 obj <>stream Blue Cross Blue Shield FEP Vision Premiums in 2022: High Option: Adhesive skin support attachment for use with external breast prosthesis, each. Services Provided by a Hospital or Other Facility, and Ambulance Services, 5(e). The protection of your privacy will be governed by the privacy policy of that site. Blue Cross and Blue Shield of North Carolina will not assign specific length of stay for patients having a mastectomy. ID 1-800-472-2689TTY: 711. %%EOF Good luck. Including codes L8000, L8002, L8010, L8015, and S8460. BCBS FEP Dental has also released a suite of new features for its mobile app, which will allow members to view benefit, coverage and claim information, and access their ID card, all in one location. Is there a Dr. that has a monthly payment plan or any kind of special offer or assistance with the price of breast implants? Breast prosthesis, not otherwise specified. This procedure is most often performed to treat breast cancer. Reconstructive breast surgery is defined as surgical procedures performed that restore the normal appearance of a breast. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. hb```@(1atZ Qr)aFKyi]8>I_13 huv1v.<4zz"@lfYXl}qjRX*:;+:;:;:LQ f Stay in-network for care. National Research Center for Women and Families: "What You Need to Know about Breast Implants." Self and Family biweekly premiums will be $212.29. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Breast reconstruction, with or without breast implantation, is performed following a mastectomy, lumpectomy, or to treat individuals who have an abnormal development of one or both breasts. Mastectomy for fibrocystic breasts not meeting the criteria as indicated in this policy is considered not medically necessary. Most physicians will offer financing through an outside financing company. **Painas an isolated symptom is an inadequate indication for implant removal. 4510 13th Ave. S. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. Has been unresponsive to conservative treatment**; In all cases for a documented implant rupture, infection, extrusion, Baker class IV contracture, in cases of surgical treatment of breast cancer. The Blue Cross Blue Shield Association negotiates annually with the U.S. Office of Personnel Management (OPM) to determine the benefits and premiums for the Blue Cross and Blue Shield Service Benefit Plan. Web1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. 2 If you have Medicare Part B primary, your costs for Thank you for your questions and photos. Insurance companies do not cover this surgery because it's "cosmetic " in nature, they do cover breast rec Fifty-three of the 57 insurance companies provided coverage for gender-affirming top surgery, after preauthorization. Nipple sparing/skin sparing mastectomy may be considered medically necessary when there is no cancer involving the skin, nipple or areola. WebSection V-Surgical Management of Breast Implants. Implantable breast prosthesis, silicone or equal. To locate the address and telephone number for a local Blue Cross and Blue Shield company, please visit fepblue.org/contact-us. Hi,Thanks for your question. Insurance companies don't cover breast implants for "cosmetic" purposes. Don't give up hope though because there are s 2023 Blue Cross Blue Shield Association. Please go to bcbsfepdental.com to see the full list of regional rates. Registered Marks of the Blue Cross and Blue Shield Association. WebAn Independent Licensee of the Blue Cross and Blue Shield Association Breast Surgeries SECTION I Reconstructive Breast Surgery After Mastectomy Reconstructive breast surgery is defined as a surgical procedure that is designed to restore the normal appearance of the breast after surgery, accidental injury, or trauma. Although cosmetic procedures are never covered by insurance, certain procedures related to your surgery may be Updated Dental and Vision Digital Sites hWmo8+|lu Self Only biweekly premiums will be $80.18 5(a). Were partnering with clinicians to ensure access to care in Massachusetts. section or contact us directly! Surgery on the contralateral breast to produce symmetry not meeting the criteria as indicated in this policy is considered not medically necessary. Professional charges for after-hours care, except when associated with services provided in a physician's office. Charges which the enrollee or Plan has no legal obligation to pay, such as excess charges for an annuitant age 65 or older who is not covered by Medicare Parts A and/or B (see page. Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals, 5(c). Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Blepharoplasty/Brow reduction/brow lift (removal of redundant skin of the upper and/or lower eyelids and protruding periorbital fat) III. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. If you're looking into the costs of breast implants for cosmetic reasons, you should also consider: Because breast implants can interfere with the accuracy of normal mammograms, women may also need extra X-ray images at additional cost. Self Only biweekly premiums will be $127.47 The Women's Health and Cancer Rights Act of 1998 (WHCRA) is federal legislation that provides that any individual, with insurance coverage who is receiving benefits in connection with a mastectomy covered by their benefit plan (whether or not for cancer) who elects breast reconstruction, must receive coverage for the reconstructive services as provided by WHCRA. ATANSYON: Si ou pale kreyl ayisyen, svis asistans nan lang disponib pou ou gratis. endstream endobj startxref Generally, you must exhibit physical, objective symptoms to qualify. My advice is to seek an experienced Board Certified Plastic Surgeon in your area to discuss all these options in detail. Breast implants are prosthetic devices used to augment, reshape, and/or 4 0 obj Topical Hyperbaric Oxygen Therapy (THBO). <> We will do our best to negotiate an individual contract with your insurance company to try to get your surgery covered. Search for Doctors, Hospitals and Dentists Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. Experimental or investigational procedures, treatments, drugs, or devices (see Section 5(b) regarding transplants). Having breast implants may also affect your insurance rates later on. Self and Family biweekly premiums will be $125.67 Research costs (costs related to conducting a clinical trial such as research physician and nurse time, analysis of results, and clinical tests performed only for research purposes). 3You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. Basic Option gives you access to our Preferred provider network that includes 96% of hospitals and 95% of doctors in the U.S. See costs for typical services when you use Preferred providers. Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen1-800-472-2689(TTY: 711). Enhanced Dental and Vision Benefits for Children Pain: In general, breast augmentation is tolerated very well. WebAlthough we may list a specific service as a benefit, we will not cover it unless we determine it is medically necessary to prevent, diagnose, or treat your illness, disease, injury, or condition. Leading the way in health insurance since 1929. Self Plus One biweekly premiums will be $289.61 1-800-472-2689(TTY: 711) . Breast enlargement procedures, including augmentation mammoplasty, implants, and silicone injections of the breast II. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. The rates presented here are for BCBS FEP Dentals most populous region, Region 1. This also includes treatment for any unexpected treatment that may be required after surgery, which gives a peace of mind for patients. We use CareCredit and Prosper. %%EOF Cost of undergoing breast augmentation at the hospitals in Birmingham area is around 4625. Systemic symptoms, attributed to connective tissue diseases, autoimmune diseases, etc. WebAdditional Costs of Breast Implant Surgery. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. Blue Shields Short Cycle Specialty Drug Program allows initial prescriptions for select Specialty Drugs to be dispensed for a 15-day trial supply. Transverse rectus abdominis myocutaneous flap (TRAM), latissimus dorsi flap or free flap. Medicare. This is all new to me & I've wanted implants since my teenage years. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Advanced care planning, except when provided as part of a covered hospice care treatment plan (see page. Call 1-800-200-4255(TTY: 711). Hi,Thanks for your question. endobj (or any amounts you desire). Self Plus One biweekly premiums will be $36.11 2 0 obj Description For members whose gender identity differs from assigned sex at birth, we traditionally cover:*. , 1-800-472-2689(: 711). Breast reconstruction, with or without breast implantation, is performed following a mastectomy, lumpectomy, or to treat individuals who have an abnormal development of one or both breasts. WASHINGTON, Sep. 30, 2021 Today the Blue Cross and Blue Shield (BCBS) Government-wide Service Benefit Plan, also known as the Federal Employee The pain should be related to the Baker classification or a diagnosis of rupture. In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including surgeon's fees, operating room costs and anesthesia)in 2022. Insurance usually will not cover breast enlargement surgery. Call 1-888-243-4420, and please let us know your preferred name and your pronouns. Includes codes L8000, L8001, L8010, L8015, and S8460. ^What youll pay for a 30-day supply of covered drugs. Applied behavior analysis (ABA) and related services for any condition other than an autism spectrum disorder. Self Only biweekly premiums will be $3.56 I have blue cross blue shield with blue local. The exclusions in this Section apply to all benefits. 1152 0 obj <> endobj <>/Metadata 1172 0 R/ViewerPreferences 1173 0 R>> Less than or equal to 12 months post mastectomy. Services, drugs, or supplies that are not medically necessary. %PDF-1.5 % If you need a breast reduction for medical or cosmetic reasons, you may be Under Basic Option, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care. pathology, does not constitute an abnormal structure (e.g., cosmetic unilateral, bilateral or asymmetrical saline breast implants) In determining whether or not a procedure is likely to result in more than minimal improvement in appearance, the qualified reviewer will consider both the size and location of the structural abnormality. The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. Wellness and Other Special Features, 5(i). Member Service 1-800-472-2689(TTY: 711). This document addresses gender affirming surgery (also known as sex affirmation surgery, gender or sex reassignment surgery, gender or sex confirmation Grade IV: Breast is hard, painful, cold, tender, and distorted. All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure. Removal of implants requires documentation of the original indication for implantation and the type of implant, either saline- or silicone gel-filled, and the current symptoms, either local or systemic. Breast prosthesis, silicone or equal, with integral adhesive. -4f$&mGI Nipple prosthesis, reusable, any type, each. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. endstream endobj 1068 0 obj <>/Metadata 46 0 R/Pages 1065 0 R/StructTreeRoot 92 0 R/Type/Catalog/ViewerPreferences 1090 0 R>> endobj 1069 0 obj <>/MediaBox[0 0 792 612]/Parent 1065 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1070 0 obj <>stream Nothing for covered preventive screenings, immunizations and services, In-network care only, except in certain situations like emergency care. External breast prosthesis garment, with mastectomy form, post mastectomy. UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstutzung zur Verfugung. Surgery* on the contralateral breast to produce a symmetrical appearance after removal of an implant and reimplantation may be considered reconstructive and medically necessary: * Types of reconstructive surgical procedures on the diseased breast include, but are not limited to: Surgery on the contralateral breast to produce symmetry not meeting the criteria as indicated in this policy is considered not medically necessary. Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross Blue Shield Association, serving residents and business in North Dakota. Reconstructive breast surgerymay be considered medically necessary forANYof the following indications: Reconstructive breast surgery after removal of an implantmay be considered medically necessary: Reconstruction may be performed by an implant-based approach or through the use of autologous tissue. There are lots of implant options out there. Includes codes L8000, L8001, L8002, L8010, and S8460. Applied behavior analysis (ABA) services and related services performed as part of an educational program; or provided in or by a school/educational setting; or provided as a replacement for services that are the responsibility of the educational system. Additional information about 2022 benefits is available online or by calling the National Information Center. Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first). Last review: July 2003. BCBS FEP Vision plans will offer a second eye exam, frame and second pair of lenses when a prescription changes for children aged 13 and under. This is a fixed cost price with unlimited follow up. Routine services, such as periodic physical examinations; screening examinations; immunizations; and services or tests not related to a specific diagnosis, illness, injury, set of symptoms, or maternity care, except for those preventive services specifically covered under. Members can expect enhanced blood pressure monitors, Pregnancy Care Boxes, breast pumps and milk storage bags. Sincerely, a mommy in need of a miracle. I'm 34 with 4 kids & a 34A. Each insurance company such as Blue Cross Blue Shield has its own standards on what qualifies a patient for insurance coverage of a breast reduction. Mastopexy. *BCBS FEP Dental rates depend upon the rate region in which a member lives. Among the changes include enhanced hypertension management and pregnancy care incentive programs, dental and vision benefits for children and the addition of a discounted supplemental international travel insurance through GeoBlue. Includes codes L8020, L8030, L8031, L8032, and L8035. Preparation of moulage for custom breast implant. . Regardless, we work extremely hard to help our patients navigate the insurance system. Augmentation changes the size and appearance of one or both breasts by transferring body fat to them or adding artificial implants. Fargo, N.D., 58121. Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. Dr. Mosser is always actively working with insurance companies to negotiate contracts. One (1) per affected side every 24 months, One (1) per affected side every 24 months. Self Plus One biweekly premiums will be $7.11 In a documented implant rupture for those individuals who had originally undergone breast implantation for reconstructive purposes; In cases of infection, extrusion, Baker class IV contracture, or surgical treatment of breast cancer. hbbd```b``3A$dll{0&S*`@RfKk@d7 Dm`:$5s2012 e bh Magnetic resonanceimaging (MRI) of the breast has been investigated By continuing to use this website, you consent to these cookies. Some have been more receptive than others. All Rights Reserved. You will have no success getting breast implants surgery covered by any insurance plan. Most physicians will offer financing through an outside fin At present, we have gotten successful insurance approval for FTM/N top surgery from the following insurers: Anthem BC : -, . Includes codes L8030, L8031, L8032, L8035, and L8039. Llame al nmero de Servicio al Cliente que figura en su tarjeta de identificacin llamada1-800-472-2689 (TTY: 711). I. For more information, view our privacy policy. Telefone para os Servios aos Membros, atravs do nmero no seu carto ID chamar1-800-472-2689 (TTY: 711). Do you have any questions? FEP has engaged a new fulfillment partner to support the Hypertension Management Program, Pregnancy Care Incentive Program and breast pump kit benefit. The mandate applies to men, as well as women. Fibrocystic breasts are considered a condition or a disorder with or without mild to severe symptoms. of breast tissue removed from each breast and who meet the following criteria: Presence of one or more of the following : A cervical or thoracic pain syndrome (upper back and shoulder pain), in which interference with daily activities or work has been documented. Self Only biweekly premiums will be $18.05 x]s6=3x;Lin4{ #Hs A $Yr"Sv]'66M1eyES-|KY]x~sg*_;69"vsY?Y3?{w5L?&`~^/I?YdPdZ8b\ Heres everything you need to know about it. Services or supplies furnished or billed by a noncovered facility, except that medically necessary prescription drugs; oxygen; and physical, speech, and occupational therapy provided by a qualified professional therapist on an outpatient basis are covered subject to Plan limits. Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). https://www.restoraaustin.com/patients/financing-options-for-cosmetic-surgery/, https://www.turklemd.com/resources/#financing. WebBreast implants complications are common and may require removal of the implant. Will having breast implants affect my coverage if I later develop, Will any of the diagnostic tests that I may need after getting breast implants, such as MRIs or extra. 2005 - 2023 WebMD LLC. BCBSNC does not provide coverage for not Services, drugs, or supplies for the treatment of obesity, weight reduction, or dietary control, except for office visits, diagnostic tests, and procedures and services for the treatment of morbid obesity listed on page. WebMD does not provide medical advice, diagnosis or treatment. WebDownload the complete manual or view individual guidelines in PDF format: Complete manual - January 2023 HMO Benefit Guidelines (PDF, 1.1 MB) Cross Reference Index Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. If you are facing this surgery, take some comfort in knowing that federal and state laws require 'lC >)a}QO=_Q Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined inconsultation with the attending physician and the individual. LL]wN^4)j,,JaAjCip%;ivVyh^J#[!|F ;'[b`4df8F682C Self Only biweekly premiums will be $53.14 ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. Grade III: Breast is firm, palpable, and the implant (or its distortion) is visible. Grade IV: Breast is hard, painful, cold, tender, and distorted. 1zGzdQp26W&YJHO2pF(ug.`Fh$5XP>C!^DmSkp_J)^)6"Y/!r7s!J/\] }} f((x )jiH9A ,-&_[7`!PWg GUb971IXsH"$I= $QDG! Only in those individuals who had originally undergone breast implantation for reconstructive purposes. Blue Cross Blue Shield healthcare plans may cover breast reduction surgery. Were proud to provide comprehensive services and compassionate support for our transgender members. Additional sources are used and can be provided HC qgV : , . Services, drugs, or supplies you receive in a country sanctioned by the Office of Foreign Assets Control (OFAC) of the U.S. Department of the Treasury, from a provider or facility not appropriately licensed to deliver care in that country. oO MmG )iYVc? }G3h!;J`"K&s,AmN{"Gq>Yos/=/#t|~\W>mC#pLF.LjG Du4z Iq :oO*eW[l$zg Services, drugs, or supplies you receive without charge while in active military service. My health insurance is an HMO plan. hbbd``b`~ H ,f@]bXu $UW4 bV+X ``0 \] : . However many plastic surgeons NSM not meeting the criteria as indicated in this policy is considered not medically necessary. Hello.Thank you for your questions. The Blue Cross and Blue Shield Association is a national federation of 34 independent, community-based and locallyoperated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. You might check out their web sites for specific information. Two companies provided coverage on a case-by case basis; one Cancer does not have to be the reason for the mastectomy. Member Discounts Take advantage of member-only discounts on health-related products and services. 1-800-472-2689 (TTY : 711) . Self Only biweekly premiums will be $9.22 WebAn Independent Licensee of the Blue Cross and Blue Shield Association Abdominoplasty, Panniculectomy and Lipectomy Policy Implementation/Update Information 10/16/12 New policy developed. ; Baker class III contractures in individuals with implants for cosmetic purposes; Rupture of a saline implant in individuals with implants for cosmetic purposes; Pain not related to contractures or rupture. There may be other exclusions and limitations listed in Section 5 of this brochure. 1 0 obj Includes codes L8000, L8001, L8002, L8015, and S8460. Please see Table Attachment for quantity limits. 1197 0 obj <>stream Don't give up hope though because there are several awesome financing companies, including CareCredit, Alphaeon and United Medical Credit. BAA !KOHWIINDZIN DOO&G&: Din4 kehj7 y1n7[tigo saad bee y1ti 47 t11j77ke bee n7k1adoowo[go 47 n1ahooti. Self and Family biweekly premiums will be $314.11 Prescriptions, services or supplies ordered, performed, or furnished by you or your immediate relatives or household members, such as spouse, parents, children, brothers, or sisters by blood, marriage, or adoption. Why Doesn't the U.S. Have at-Home Tests for the Flu? Any advice? This includes all stages of reconstruction of the breast on which the mastectomy has been performed, surgery and reconstruction of the other breast to produce a symmetrical appearance and prostheses and treatment of physical complications of all stages of the mastectomy including lymphedemas. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. x( &wF@R\XYK00Ha,le+j p ATTENTION : si vous parlez franais, des services dassistance linguistique sont disponibles gratuitement.
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