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Under Basic Option, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care. x( &wF@R\XYK00Ha,le+j p ID 1-800-472-2689TTY 711). One (1) per affected side within 24 months. The exclusions in this Section apply to all benefits. endstream endobj startxref Breast enlargement procedures, including augmentation mammoplasty, implants, and silicone injections of the breast II. Last review: July 2003. We have Member Service associates who can review your benefits and costs, and help you find a doctor who fits your needs. Lumpectomy is the removal of the breast tumor and surrounding tissue. Includes codes L8001, L8002, L8010, L8015, and S8460. Most surgeons do offer financing through outside companies such as Care credit for example. D77 bee an7tah7g7 ninaaltsoos bined44 n0omba bik17g7ij8 b44sh bee hod77lnih call1-800-472-2689(TTY: 711). Individuals, regardless of BSA, who are anticipated to have at least 1 kg. The 35 local member companies of the Blue Cross Blue Shield Association are the primary points of contact for Service Benefit Plan members. Before making a final decision, please read the Plans federal brochure (RI 71-005). Self Plus One biweekly premiums will be $114.25 The presence of symptoms related to your large breast size such as neck/back/shoulder pain are important in showing medical necessity, which it sounds like you have from your : . %%EOF For instance, some insurers won't cover diseases of the breast - including breast cancer -- if you have breast implants. Before making a final decision, please read the Plans federal brochure (RI 71-005). This is a fixed cost price with unlimited follow up. 4 0 obj Professional charges for after-hours care, except when associated with services provided in a physician's office. I'm currently pear shaped. Mastectomy for fibrocystic breasts not meeting the criteria as indicated in this policy is considered not medically necessary. If you do not see your insurer on this list, please contact us. Augmentation changes the size and appearance of one or both breasts by transferring body fat to them or adding artificial implants. endstream endobj 1071 0 obj <>stream 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. Standard Option: Chin augmentation (reshaping or enhancing the size of the chin) Grade II: Breast is less soft and the implant can be palpated but is not visible. Reconstructive breast surgery not meeting the criteria as indicated in this policy is considered not medically necessary. 7; 2023 Blue Cross Blue Shield Association. As with other types of cosmetic 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. No-indicates the removal would be considered not medically necessary. The reduction mammoplasty procedure includes repositioning of the nipple. I don't know if silicone or saline is best & not sure on either a C or D cup. Custom breast prosthesis, post mastectomy, molded to individual model. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia con el idioma. Sincerely, a mommy in need of a miracle. Services that do not meet the criteria of this policy will be considered not medically necessary. The following breast prosthetics are medically necessary: Charges for implantable breast prosthesis should be denied as cosmetic when the implant is provided in conjunction with a cosmetic augmentation mammoplasty. Self and Family biweekly premiums will be $125.67 ATENO: Se fala portugus, so-lhe disponibilizados gratuitamente servios de assistncia de idiomas. <>/Metadata 1172 0 R/ViewerPreferences 1173 0 R>> X%XqH v3^w)LSxQ BKJ/7iSq! 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. HZjz:|QkM]h]\ The following is an outline based on some of these variables:1. : -, . PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. ; 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. : , . For example, the process of getting implants will require an dental exam and some X-rays, both of which may be covered by a Blue Cross Blue Shield Medicare Advantage plan that Internal Medical Policy Committee 11-14-2019 incorporate Table into policy; removal of procedure code 19304; Add Procedure code L8033, Internal Medical Policy Committee 11-19-2020 Criteria updated, Internal Medical Policy Committee 11-23-2021 Annual Review, no changes in criteria, Fargo (Headquarters) Check out the changes and updates to our plan in 2023. Limit your coverage. Our AskBlueSMFEP Medical Plan Finder tool can help you select the right option for your needs. Surgery on the Contralateral Breast to Produce Symmetry. 1-800-472-2689(TTY: 711). Members can expect enhanced blood pressure monitors, Pregnancy Care Boxes, breast pumps and milk storage bags. 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. Llame al nmero de Servicio al Cliente que figura en su tarjeta de identificacin llamada1-800-472-2689 (TTY: 711). endobj 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. All changes will take effect Jan. 1, 2022. There may be other exclusions and limitations listed in Section 5 of this brochure. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Services, Drugs, and Supplies Provided Overseas, Non-FEHB Benefits Available to Plan Members. This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. With enhanced benefits in all products in 2022, FEP continues its mission to provide unparalleled products and services to our members and their families.. 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. Please see your subscriber certificate for details about your plan coverage. BAA !KOHWIINDZIN DOO&G&: Din4 kehj7 y1n7[tigo saad bee y1ti 47 t11j77ke bee n7k1adoowo[go 47 n1ahooti. x]s6=3x;Lin4{ #Hs A $Yr"Sv]'66M1eyES-|KY]x~sg*_;69"vsY?Y3?{w5L?&`~^/I?YdPdZ8b\ Advanced care planning, except when provided as part of a covered hospice care treatment plan (see page. Includes codes L8000, L8001, L8002, L8015, and S8460. hWmo8+|lu It is slightly more challenging to get coverage for MTF/N breast augmentation procedures, but it is certainly still achievable. LL]wN^4)j,,JaAjCip%;ivVyh^J#[!|F ;'[b`4df8F682C Topical Hyperbaric Oxygen Therapy (THBO). WebMD does not provide medical advice, diagnosis or treatment. 1197 0 obj <>stream Self Only biweekly premiums will be $53.14 1114 0 obj <>stream Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689(TTY: 711). This is all new to me & I've wanted implants since my teenage years. <> Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele1-800-472-2689 TTY: 711). Before you get breast implants, ask your insurance company these five questions: Get the answers in writing and check back with your insurance company every couple of years, since it may change its policy. You might check out their web sites for specific information. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> **Painas an isolated symptom is an inadequate indication for implant removal. Travel expenses except as specifically provided for covered transplants performed in a Blue Distinction Center for Transplant (see page. Services or supplies for which no charge would be made if the covered individual had no health insurance coverage. 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. If you have prescription drug coverage with us and are having trouble refilling a prescription, help is available. 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. In such circumstances the specialty drug Two companies provided coverage on a case-by case basis; one Blue Cross Blue Shield FEP Vision Premiums in 2022: High Option: Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Mastectomy is the removal of all or part of a breast and is typically performed as a treatment for cancer, or in some cases for the treatment of benign disease. To locate the address and telephone number for a local Blue Cross and Blue Shield company, please visit fepblue.org/contact-us. Breast prosthesis, silicone or equal, with integral adhesive. Insurance usually will not cover breast enlargement surgery. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. hb```@(1atZ Qr)aFKyi]8>I_13 huv1v.<4zz"@lfYXl}qjRX*:;+:;:;:LQ f We offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. Mayo Clinic: "Breast Augmentation: Breast Implants Reshape Self-Image." $15copay all additional visits, Inpatient (Precertification is required): $250per day copay; up to $1,500per admission, Outpatient: $150copay per day per facility1, Earn $50 for completing the Blue Health Assessment3, Earn up to $120 for completing three eligible Online Health Coachgoals3. stream 1-800-472-2689(TTY: 711) . Dear Geneseo,Thank you for your post. May 21, 2016. WASHINGTON, Sep. 30, 2021 Today the Blue Cross and Blue Shield (BCBS) Government-wide Service Benefit Plan, also known as the Federal Employee Personal comfort items such as beauty and barber services, radio, television, or phone. Thank you for your question. 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. Services, drugs, or supplies you receive without charge while in active military service. Lack of imaging confirmation of rupture in association with persistent local symptoms requires case by case consideration. %%EOF For information on obtaining prior approval for specific services, such as transplants, see Section 3, You need prior Plan approval for certain services. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. The benefits of coconut, argan, tea tree and more. 1Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. Breast prosthesis, not otherwise specified. BCBS FEP Dental Standard Option will cover Class A (Basic), B (Intermediate), and C (Major) services for children at 100% when these services are provided by in-network providers. Includes codes L8020, L8030, L8031, L8032, and L8039. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. Services, drugs, or supplies not required according to accepted standards of medical, dental, or psychiatric practice in the United States. ~pZEKFj{&{=)! mw@^3?y&s7wf(GpQ(GqQUiG Grade IV: Breast is hard, painful, cold, tender, and distorted. FDA: "FDA Breast Implant Consumer Handbook." The protection of your privacy will be governed by the privacy policy of that site. You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. Procedure Codes Breast Prosthetics The following breast prosthetics are medically necessary: Breast prosthesis, mastectomy bra. The pain should be related to the Baker classification or a diagnosis of rupture. Furniture (other than medically necessary durable medical equipment) such as commercial beds, mattresses, chairs. The type of mastectomy (subcutaneous, partial, modified, or radical) and the timing of the surgery vary for each individual and are determined by the surgeon. endstream endobj startxref We will do our best to negotiate an individual contract with your insurance company to try to get your surgery covered. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined inconsultation with the attending physician and the individual. For members whose gender endstream endobj 1153 0 obj <. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. This document addresses gender affirming surgery (also known as sex affirmation surgery, gender or sex reassignment surgery, gender or sex confirmation And if youre not sure just call us. endobj Is there a rule of thumb or tips for choosing breast augmentation sizes? Breast implants are prosthetic devices used to augment, reshape, and/or 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. 2 0 obj There are lots of implant options out there. In those individuals who had originally undergone breast implantation for reconstructive purposes. %PDF-1.7 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. Services, drugs, or supplies you receive for cosmetic purposes. : , , . The information on RealSelf is intended for educational purposes only. 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. Milliman Care Guidelines (MCG) and the CMS Provider Reimbursement Manual. Less than or equal to 12 months post mastectomy. BCBSNC does not provide coverage for not You can also visit our Mental Health Resource Center to learn more. Implantable breast prosthesis, silicone or equal. Membership or concierge service fees charged by a healthcare provider. %PDF-1.7 % Basic Option: External breast prosthesis garment, with mastectomy form, post mastectomy. However many plastic surgeons 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. Registered Marks of the Blue Cross and Blue Shield Association. Self and Family biweekly premiums will be $54.16, Standard Option: I'm 34 with 4 kids & a 34A. At present, we have gotten successful insurance approval for FTM/N top surgery from the following insurers: Unfortunately, we do not accept Medicare at this time. This procedure is most often performed to treat breast cancer. Fibrocystic breasts are considered a condition or a disorder with or without mild to severe symptoms. 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. Step 1: Cut off foot of panty hose and insert dry long grain rice and tie the ends. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. Don't give up hope though because there are several awesome financing companies, including CareCredit, Alphaeon and United Medical Credit. Insurance companies don't cover breast implants for "cosmetic" purposes. Most physicians will offer financing through an outside financing company. q/J 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. sf%paPEs4J Our insurance negotiation team is amazing and we would love to add more insurance plans to this list. Self Plus One biweekly premiums will be $196.13 Additional sources are used and can be provided Were partnering with clinicians to ensure access to care in Massachusetts. **Conservative treatment for fibrocystic breasts consists of, but is not limited to: support bras, avoiding trauma, avoiding caffeine, medication for pain, anti-inflammatory drugs, hormonal manipulation, use of vitamin E, use of diuretics, and salt restrictions. Two (2) within 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. Cancer does not have to be the reason for the mastectomy. Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. Grade I:Augmented breast feels as soft as a normal breast. Member Discounts Take advantage of member-only discounts on health-related products and services. Learn how were working to make health care more equitable. Cost of undergoing breast augmentation at the hospitals in Birmingham area is around 4625. : , . Enhanced Dental and Vision Benefits for Children One (1) within 24 months for silicone prostheses per affected side. Grade IV: Breast is hard, painful, cold, tender, and distorted. h0N``r4:pV}/bI32kiXrAy c:&[ Some insurance companies consider breast augmentation surgery a "pre-existing condition," and some women who have had breast implants have found that they have problems getting health care coverage. Whether 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. DrMaz. section or contact us directly! Self Only biweekly premiums will be $18.05 hbbd```b``3A$dll{0&S*`@RfKk@d7 Dm`:$5s2012 e bh Wellness and Other Special Features, 5(i). hb```,RQ Systemic symptoms, attributed to connective tissue diseases, autoimmune diseases, etc. Includes codes L8020, L8030, L8031, L8032, and L8035. Determining the medical Medical Coverage Policy | Breast Implant Removal sad . Call 1-800-200-4255(TTY: 711). How Long is Breast Implants Recovery Time? While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. Services, drugs, or supplies you receive while you are not enrolled in this Plan. $30 copayfor primary care1 Is there a Dr. that has a monthly payment plan or any kind of special offer or assistance with the price of breast implants? Although cosmetic procedures are never covered by insurance, certain procedures related to your surgery may be Includes codes L8030, L8031, L8032, L8035, and L8039. To access your member services, please visit your BCBS company. Services, drugs, or supplies that are not medically necessary. 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. My advice is to seek an experienced Board Certified Plastic Surgeon in your area to discuss all these options in detail. WebReview the links below for information relevant to your coverage. As we continue to navigate an unprecedented health crisis, Blue Cross Blue Shield FEP health, dental and vision members know they can count on us to make sure affordable and comprehensive health care is accessible no matter where they are, said William A. Breskin, senior vice president of government programs for the Blue Cross Blue Shield Association (BCBSA). Each member of a Basic Option plan who has Medicare Part A and Part B can get reimbursed up to $800 per year for paying their Medicare Part B premiums. Complications of breast implants are common and may require removal of the implant. Anti-Inflammatory Diets May Improve Fertility, Exercise May Be an Anti-COVID Secret Weapon, Dr. Whyte's Book: Take Control of Your Diabetes Risk, Street Medicine Reaches People Where They Live, Health News and Information, Delivered to Your Inbox, Breast Implants (Breast Augmentation) Home, 5 Questions to Ask Your Health Insurance Company, Additional Costs of Breast Implant Surgery, Insurance Eligibility and Breast Implants, Breast Implants: Types, Cost, Problems, and Recovery, Facts About Breast Implants and Health Insurance. Registered Marks of Blue Cross and Blue Shield of Massachusetts, Inc., or Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. Registered Marks, TM Trademarks. WebBreast implants complications are common and may require removal of the implant. *Your benefits and coverage may vary. 1067 0 obj <> endobj 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.
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