Including codes L8000, L8002, L8010, L8015, and S8460. Mastectomy for fibrocystic breasts may be considered medically necessary: *Symptoms of fibrocystic breasts include, but are not limited to: breast engorgement attended by pain and tenderness, generalized lumpiness or isolated mass or cyst. Please call 1-888-243-4420 for more information. BCBSNC does not provide coverage for not : , , : .. 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. hbbd```b``3A$dll{0&S*`@RfKk@d7 Dm`:$5s2012 e bh You might check out their web sites for specific information. %PDF-1.7 Mastopexy. Grade II: Breast is less soft and the implant can be palpated but is not visible. All rights reserved. This is all new to me & I've wanted implants since my teenage years. Abdominoplasty and Lipectomy are considered cosmetic and not medically necessary for all applications. Registered Marks of the Blue Cross and Blue Shield Association. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689(TTY: 711). Travel expenses except as specifically provided for covered transplants performed in a Blue Distinction Center for Transplant (see page. Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware of. Regardless, we work extremely hard to help our patients navigate the insurance system. 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Springfield Named President of Blue Cross and Blue Shield of Texas. Although cosmetic procedures are never covered by insurance, certain procedures related to your surgery may be Lumpectomy is the removal of the breast tumor and surrounding tissue. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. h0N``r4:pV}/bI32kiXrAy c:&[ <> For members whose gender 1Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. 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. Magnetic resonanceimaging (MRI) of the breast has been investigated Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. Mastectomy for fibrocystic breasts not meeting the criteria as indicated in this policy is considered not medically necessary. Most surgeons do offer financing through outside companies such as Care credit for example. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. Dear Geneseo,Thank you for your post. Fibrocystic breasts are considered a condition or a disorder with or without mild to severe symptoms. 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 You can also visit our Mental Health Resource Center to learn more. May 21, 2016. Chin augmentation (reshaping or enhancing the size of the chin) ATTENTION : si vous parlez franais, des services dassistance linguistique sont disponibles gratuitement. 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. 2020 Blue Cross Blue Shield Association. One (1) per affected side every three (3) months. Services or supplies we are prohibited from covering under the Federal Law. 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 Nipple tattooing will be covered if the medical necessity criteria for reconstructive breast surgery are met. : . Includes codes L8020, L8030, L8031, L8032, and L8039. WASHINGTON, Sep. 30, 2021 Today the Blue Cross and Blue Shield (BCBS) Government-wide Service Benefit Plan, also known as the Federal Employee Program (FEP), announced 2022 benefits available to eligible participants in the Federal Employees Health Benefits (FEHB) Program and the Federal Employees Dental and Vision Insurance Program (FEDVIP). Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. 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. 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. . Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Quantity Level Limits For Breast Prosthetics. 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. : , . 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. hbbd``b`~ H ,f@]bXu $UW4 bV+X ``0 \] Blepharoplasty/Brow reduction/brow lift (removal of redundant skin of the upper and/or lower eyelids and protruding periorbital fat) III. However, health insurance companies can: SOURCES: Implant Information Project: "What You Need to Know Before You Get Breast Implants." 1114 0 obj <>stream BAA !KOHWIINDZIN DOO&G&: Din4 kehj7 y1n7[tigo saad bee y1ti 47 t11j77ke bee n7k1adoowo[go 47 n1ahooti. *BCBS FEP Dental rates depend upon the rate region in which a member lives. To locate the address and telephone number for a local Blue Cross and Blue Shield company, please visit fepblue.org/contact-us. Often, with the efforts of both patient and physician, we can get an individual covered. Hi,Thanks for your question. (or any amounts you desire). 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. By continuing to use this website, you consent to these cookies. 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. Please see your subscriber certificate for details about your plan coverage. Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined inconsultation with the attending physician and the individual. Whether Determining the medical Medical Coverage Policy | Breast Implant Removal sad . All Rights Reserved. $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 You will have no success getting breast implants surgery covered by any insurance plan. Most physicians will offer financing through an outside fin Includes codes L8000, L8002, L8010, L8015, and S8460. Incontinence products such as incontinence garments (including adult or infant diapers, briefs, and underwear), incontinence pads/liners, bed pads, or disposable washcloths. endobj DrMaz. Please review the terms of use and privacy policies of the new site you will be visiting. Breast prosthesis, silicone or equal, with integral adhesive. For example, your policy will likely exclude coverage of surgery to improve the appearance of your breasts. Reduction mammoplasty. ` D9? Call 1-800-200-4255(TTY: 711). If I have health complications related to my breast implants, will the necessary treatment or surgery be covered? ART-20203231. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. There may be other exclusions and limitations listed in Section 5 of this brochure. 1089 0 obj <>/Filter/FlateDecode/ID[<50450C2B75DCDF4CB37C20535D129F89><28C61A8B7ECC9640B72333AA8FDFF1D6>]/Index[1067 48]/Info 1066 0 R/Length 109/Prev 449243/Root 1068 0 R/Size 1115/Type/XRef/W[1 3 1]>>stream Procedure Codes Breast Prosthetics The following breast prosthetics are medically necessary: Breast prosthesis, mastectomy bra. Augmentation changes the size and appearance of one or both breasts by transferring body fat to them or adding artificial implants. 1152 0 obj <> endobj This is the common pathway we use to work our way through the system. The following is an outline based on some of these variables:1. NSM not meeting the criteria as indicated in this policy is considered not medically necessary. HMOs. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Additional information about 2022 benefits is available online or by calling the National Information Center. Two (2) within 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. : , . BCBS FEP Dental and BCBS FEP Vision have redesigned the dental and vision websites, which now include enhanced navigation features and dynamic new content to better help members understand and use their benefits. WebAdditional Costs of Breast Implant Surgery. All changes will take effect Jan. 1, 2022. Learn how were working to make health care more equitable. ])h|w 2 Coi)j(~I9\W*{/LWnne=-9Mj0~5E 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. 1-800-472-2689( . . .: 711). Is there a rule of thumb or tips for choosing breast augmentation sizes? 1067 0 obj <> endobj Hello.Thank you for your questions. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Find out who qualifies for Blue Cross Blue Shield breast reduction coverage. Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE (2583). Pain: In general, breast augmentation is tolerated very well. Cancer does not have to be the reason for the mastectomy. WebBreast implants complications are common and may require removal of the implant. We have Member Service associates who can review your benefits and costs, and help you find a doctor who fits your needs. Removal of a silicone gel-filledbreast implant may be considered medically necessary: Removal of a saline-filledbreast implant may be considered medically necessary forEITHERof the following indications: Removal of a breast implant associated with a Baker class III contracturemay be considered medically necessary: The following indications for removal of breast implants are considerednot medically necessary: Removal of breast implant not meeting the criteria as indicated in this policy is considered not medically necessary. ID 1-800-472-2689TTY: 711. 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. Self Only biweekly premiums will be $53.14 With enhanced benefits in all products in 2022, FEP continues its mission to provide unparalleled products and services to our members and their families.. Blue Cross Blue Shield FEP Vision Premiums in 2022: High Option: We use CareCredit and Prosper. 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. 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. Grade II:Breast is less soft and the implant can be palpated but is not visible. Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. If you do not see your insurer on this list, please contact us. If you have prescription drug coverage with us and are having trouble refilling a prescription, help is available. 7; Self Plus One biweekly premiums will be $196.13 Milliman Care Guidelines (MCG) and the CMS Provider Reimbursement Manual. If additional surgery is required for either breast for treatment of physical complications of the implant or reconstruction, surgery on the other breast to produce a symmetrical appearance is reconstructive at that point as well. 500 If you need further surgery later on, your health insurance may not cover that, either. LU . Self Only biweekly premiums will be $127.47 The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. Complications of breast implants are common and may require removal of the implant. Standard Option: ***Contractureshave been graded according to the Baker Classification which is outlined below: Grade I: Augmented breast feels as soft as a normal breast. By clicking Subscribe, I agree to the WebMD, Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, 6 Minutes of Exercise May Protect Brain From Alzheimer's, 'Disturbing' Rate of Adverse Events During Hospital Stays. Sometimes, we can work with the HR department of larger companies (especially the ones with more progressive attitudes) to help make your surgery possible. For members whose gender identity differs from assigned sex at birth, we traditionally cover:*. 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. Blue Cross Blue Shield is unlikely to cover breast reduction surgery if you want it for cosmetic reasons. Additional sources are used and can be provided Cost of undergoing breast augmentation at the hospitals in Birmingham area is around 4625. * Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. Telefone para os Servios aos Membros, atravs do nmero no seu carto ID chamar1-800-472-2689 (TTY: 711). As with other types of cosmetic 1197 0 obj <>stream Services, drugs, or supplies related to sexual dysfunction or sexual inadequacy (except for surgical placement of penile prostheses to treat erectile dysfunction and gender reassignment surgeries specifically listed as covered). hb```,RQ euIJ~rK?EWSML[!A`Hx-H"`x]74,%{WJ2hP'U0JAH UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. 1170 0 obj <>/Filter/FlateDecode/ID[]/Index[1152 46]/Info 1151 0 R/Length 91/Prev 123788/Root 1153 0 R/Size 1198/Type/XRef/W[1 2 1]>>stream Member Service 1-800-472-2689(TTY: 711). Surgery on the Contralateral Breast to Produce Symmetry. LL]wN^4)j,,JaAjCip%;ivVyh^J#[!|F ;'[b`4df8F682C Members can expect enhanced blood pressure monitors, Pregnancy Care Boxes, breast pumps and milk storage bags. Custom breast prosthesis, post mastectomy, molded to individual model. }3{8d[?J!>A!j,)b6:ad>LfKfpXcl)'\dnLf4T#Dz|z#wXhhr:hsZp? Most women have to pay that out of their own pockets. 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. Were proud to provide comprehensive services and compassionate support for our transgender members. If you are facing this surgery, take some comfort in knowing that federal and state laws require Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Calf implants IV. Llame al nmero de Servicio al Cliente que figura en su tarjeta de identificacin llamada1-800-472-2689 (TTY: 711). The protection of your privacy will be governed by the privacy policy of that site. Orthodontic care for malposition of the bones of the jaw or for temporomandibular joint (TMJ) syndrome. 2005 - 2023 WebMD LLC. Our AskBlueSMFEP Medical Plan Finder tool can help you select the right option for your needs. 2021 Blue Cross and Blue Shield of Massachusetts, Inc., or Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. Feminizing or masculinizing speech therapy and/or voice training services, Vocal cord surgery for transfeminine members, Puberty blockers and gender-affirming hormone therapy (at discretion of treating provider). *Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including surgeon's fees, operating room costs and anesthesia)in 2022. Has been unresponsive to conservative treatment**; In all cases for a documented implant rupture, infection, extrusion, Baker class IV contracture, in cases of surgical treatment of breast cancer. The researchers analyzed coverage status from 57 US insurance companies, only one of which had no relevant policy on these procedures. hWmo8+|lu Advanced care planning, except when provided as part of a covered hospice care treatment plan (see page. The Blue Cross and Blue Shield Service Benefit Plan, also known as the Federal Employee Program (FEP), has been part of the Federal Employees Health Benefits (FEHB) Program since its inception in 1960. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. Our insurance negotiation team is amazing and we would love to add more insurance plans to this list. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Naley zadzwoni do Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689(TTY: 711). Professional charges for after-hours care, except when associated with services provided in a physician's office. %8eRq xq{2cQ'YzRh(KE&WNO-ID.}16m', ~D[+d\q~0}h(U~LG 1ek[FZOvM) .P=xgu`E)I M p_]pV#g$ RkPGV9& G{(TRp. Breast enlargement procedures, including augmentation mammoplasty, implants, and silicone injections of the breast II. endstream endobj startxref ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. WebReview the links below for information relevant to your coverage. Mastectomy is the removal of all or part of a breast and is typically performed as a treatment for cancer, or sometimes for the treatment of benign disease. Good luck. In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. FEP Blue Focus: Includes codes L8000, L8001, L8010, L8015, and S8460. Alternative medicine services including, but not limited to, botanical medicine, aromatherapy, herbal/nutritional supplements (see page. Stay in-network for care. With PPO insurance plans that cover transgender surgery, we are usually able to get a portion (if not all) of the surgery covered. Any advice? Grade III: Breast is firm, palpable, and the implant (or its distortion) is visible. Nothing for covered preventive screenings, immunizations and services, In-network care only, except in certain situations like emergency care. Generally, you must exhibit physical, objective symptoms to qualify. It covers roughly 5.6 million federal employees, retirees and their families out of the more than 8.5 million people who receive their benefits through the FEHB Program. 1 0 obj Hello.Thank you for your questions. Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware Eligible participants will have an opportunity to make their coverage decisions during Open Season, which runs from Nov. 8 through Dec. 13, 2021. Includes codes L8000, L8001, L8002, L8015, and S8460. Services or supplies for which no charge would be made if the covered individual had no health insurance coverage. Description 2023 Blue Cross Blue Shield of North Dakota, Please wait while your form is being submitted, Directory Validation Instructions (No Surprises Act), Recredentialing & Credentialing Applications. 4 0 obj The pain should be related to the Baker classification or a diagnosis of rupture. Includes codes L8030, L8031, L8032, L8035, and L8039. $40copay for specialists1, $0 for first 2 visits My health insurance is an HMO plan. Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals, 5(c). They are responsible for processing claims and providing customer service to our members. This specialized team of clinical experts, mental health experts, and psychiatrists is available for comprehensive support. Transverse rectus abdominis myocutaneous flap (TRAM), latissimus dorsi flap or free flap. Nipple prosthesis, reusable, any type, each. And if youre not sure just call us. **Conservative treatment for fibrocystic breasts consists of, but is not limited to: support bras, avoiding trauma, avoiding caffeine, medication for pain, anti-inflammatory drugs, hormonal manipulation, use of vitamin E, use of diuretics, and salt restrictions. Fargo, N.D., 58121. -4f$&mGI The exclusions in this Section apply to all benefits. 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. endobj Enhanced Dental and Vision Benefits for Children Refer to Table Attachment for a chart to assist with medical necessity determination for implant removal. New Enhanced Benefit Programs Step 1: Cut off foot of panty hose and insert dry long grain rice and tie the ends. Self Only biweekly premiums will be $3.56 Self Only biweekly premiums will be $9.22 Good luck. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral. This is a fixed cost price with unlimited follow up. To access your member services, please visit your BCBS company. Services, drugs, or supplies related to medical marijuana. 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. 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. %PDF-1.7 % Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Before making a final decision, please read the Plans federal brochure (RI 71-005). Limit your coverage. 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. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. , 1-800-472-2689(: 711). Blue Cross Blue Shield healthcare plans may cover breast reduction surgery. The information on RealSelf is intended for educational purposes only. %PDF-1.5 % WebThe reason we cant give a simple yes or no answer is because every insurance company handles cosmetic surgery procedures differently, and since breast implant removal is considered cosmetic surgery, youll have to consult your plans list of covered benefits to determine how much, if any, your insurance company will pay toward this procedure. Services Provided by a Hospital or Other Facility, and Ambulance Services, 5(e). Services, drugs, or supplies you receive from noncovered providers. WebScreening uses include screening for breast cancer in patients who are at high genetic risk for breast cancer. Surgery on the contralateral breast to produce symmetry not meeting the criteria as indicated in this policy is considered not medically necessary. X%XqH v3^w)LSxQ BKJ/7iSq! Services, drugs, or supplies related to abortions, except when the life of the mother would be endangered if the fetus were carried to term, or when the pregnancy is the result of an act of rape or incest. endstream endobj 1071 0 obj <>stream D77 bee an7tah7g7 ninaaltsoos bined44 n0omba bik17g7ij8 b44sh bee hod77lnih call1-800-472-2689(TTY: 711). Is there a Dr. that has a monthly payment plan or any kind of special offer or assistance with the price of breast implants? 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. Preparation of moulage for custom breast implant. $30 copayfor primary care1 Services, drugs, or supplies you receive for cosmetic purposes. EUmsCd}]'`d w! M ! Two (2) every 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. **Painas an isolated symptom is an inadequate indication for implant removal. I'm currently pear shaped. You will have no success getting breast implants surgery covered by any insurance plan. Medicare Advantage members, please call 877-817-0493 all other members please call, 877-817-0477. WebMinimum proposed specimen weights (both breasts combined) (glandular tissue) should be 0.4 kg for women weighing less the 60 kg (132#), 0.7 kg for women weighing 60-80 kg (132-176#), and 1 kg for women weighing more than 80 kg (176#).

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