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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 FEP offers a comprehensive suite of resources to help current and prospective members choose the best medical, dental and vision plan for them and their families, including the AskBlue medical, dental and vision plan finder tools, prescription drug cost tool and health cost advisor tool. Call 1-800-200-4255(TTY: 711). Services, drugs, or supplies not required according to accepted standards of medical, dental, or psychiatric practice in the United States. Contracted insurance plans. We will do our best to negotiate an individual contract with your insurance company to try to get your surgery covered. 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. 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. Includes codes L8001, L8002, L8010, L8015, and S8460. Web1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. 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. May 21, 2016. Services, drugs, or supplies you receive while you are not enrolled in this Plan. Step 1: Cut off foot of panty hose and insert dry long grain rice and tie the ends. **Painas an isolated symptom is an inadequate indication for implant removal. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. ATENO: Se fala portugus, so-lhe disponibilizados gratuitamente servios de assistncia de idiomas. 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). 2005 - 2023 WebMD LLC. Note: Surgical services for our youngest members are considered on a case-by-case basis. , 1-800-472-2689(: 711). x( &wF@R\XYK00Ha,le+j p The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. 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. Breast implants are prosthetic devices used to augment, reshape, and/or Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware of. 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. For members whose gender endstream endobj 1071 0 obj <>stream All changes will take effect Jan. 1, 2022. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. D77 bee an7tah7g7 ninaaltsoos bined44 n0omba bik17g7ij8 b44sh bee hod77lnih call1-800-472-2689(TTY: 711). Augmentation changes the size and appearance of one or both breasts by transferring body fat to them or adding artificial implants. Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first). 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. WebAdditional Costs of Breast Implant Surgery. 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. Adhesive skin support attachment for use with external breast prosthesis, each. Experimental or investigational procedures, treatments, drugs, or devices (see Section 5(b) regarding transplants). Tricare/Champus. We use CareCredit and Prosper. Ask your health insurance company ahead of time so you know what to expect. 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. Includes codes L8000, L8001, L8010, L8015, and S8460. Self and Family biweekly premiums will be $27.67. 3 0 obj Additional sources are used and can be provided 0 Blue Cross and Blue Shield of North Carolina will not assign specific length of stay for patients having a mastectomy. Furniture (other than medically necessary durable medical equipment) such as commercial beds, mattresses, chairs. Members can expect enhanced blood pressure monitors, Pregnancy Care Boxes, breast pumps and milk storage bags. %vH>jJ(BS+4t|!vLSM z7&^\&gN;ObtGn=M&qbn' IL\] #5!qgu02>/qdV&JUNeHyYYQD-LKR(=#s!R{@*^Gg&lrGAegn[R-{.{/om?DiQiH9e1A Two (2) every 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. Grade II:Breast is less soft and the implant can be palpated but is not visible. We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. ID 1-800-472-2689TTY 711). Milliman Care Guidelines (MCG) and the CMS Provider Reimbursement Manual. This specialized team of clinical experts, mental health experts, and psychiatrists is available for comprehensive support. If you need further surgery later on, your health insurance may not cover that, either. $40copay for specialists1, $0 for first 2 visits : , . Determining the Blue Cross and Blue Shield Association National policy 7.01.22 Reconstructive Breast Surgery/Management of Breast Implants. I don't know if silicone or saline is best & not sure on either a C or D cup. In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including ! Services, drugs, or supplies you receive for cosmetic purposes. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral. Self Only biweekly premiums will be $53.14 Breast reconstruction, with or without breast implantation, is performed following a mastectomy, lumpectomy, or to treat individuals who have an abnormal development of one or both breasts. Why Doesn't the U.S. Have at-Home Tests for the Flu? ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. Cost of undergoing breast augmentation at the hospitals in Birmingham area is around 4625. of breast tissue removed from each breast and who meet the following criteria: Presence of one or more of the following : A cervical or thoracic pain syndrome (upper back and shoulder pain), in which interference with daily activities or work has been documented. Meet with a board certified plastic surgeon to discuss your goals, get a quote and find out what financing options they offer.Best of Luck! There are lots of implant options out there. However many plastic surgeons Although cosmetic procedures are never covered by insurance, certain procedures related to your surgery may be Alternative medicine services including, but not limited to, botanical medicine, aromatherapy, herbal/nutritional supplements (see page. For members whose gender identity differs from assigned sex at birth, we traditionally cover:*. oO MmG )iYVc? }G3h!;J`"K&s,AmN{"Gq>Yos/=/#t|~\W>mC#pLF.LjG Du4z Iq :oO*eW[l$zg Self and Family biweekly premiums will be $10.67, Blue Cross Blue Shield FEP Dental Premiums in 2022*, High Option: How Long is Breast Implants Recovery Time? . Insurance usually will not cover breast enlargement surgery. Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. 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. Grade II: Breast is less soft and the implant can be palpated but is not visible. ^What youll pay for a 30-day supply of covered drugs. Services, drugs, or supplies related to medical marijuana. Self Plus One biweekly premiums will be $18.44 When the implant was originally placed for reconstructive purposes in an individual with a history of mastectomy, lumpectomy or treatment of breast cancer. Greater than or equal to 13 months post mastectomy. Reduction mammoplasty. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. : -, . With enhanced benefits in all products in 2022, FEP continues its mission to provide unparalleled products and services to our members and their families.. . Most surgeons do offer financing through outside companies such as Care credit for example. : , , . It is slightly more challenging to get coverage for MTF/N breast augmentation procedures, but it is certainly still achievable. 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. 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. 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) Self Plus One biweekly premiums will be $36.11 Do you have any questions? Last review: July 2003. Medicaid. 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. euIJ~rK?EWSML[!A`Hx-H"`x]74,%{WJ2hP'U0JAH section or contact us directly! Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Self Only biweekly premiums will be $80.18 It will, though, cover breast implants for women who have had mastectomies due to breast cancer. Personal comfort items such as beauty and barber services, radio, television, or phone. <>/Metadata 1172 0 R/ViewerPreferences 1173 0 R>> Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Is there a Dr. that has a monthly payment plan or any kind of special offer or assistance with the price of breast implants? Llame al nmero de Servicio al Cliente que figura en su tarjeta de identificacin llamada1-800-472-2689 (TTY: 711). : , . Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). 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 rates presented here are for BCBS FEP Dentals most populous region, Region 1. 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. Augmentation mammoplasty. Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals, 5(c). Cancer does not have to be the reason for the mastectomy. Applied behavior analysis (ABA) and related services for any condition other than an autism spectrum disorder. Dear Geneseo,Thank you for your post. Nipple tattooing is considered cosmetic for all other indications. %PDF-1.5 % We have Member Service associates who can review your benefits and costs, and help you find a doctor who fits your needs. Good luck. Regardless, we work extremely hard to help our patients navigate the insurance system. One (1) per affected side every three (3) months. Implantable breast prosthesis, silicone or equal. Blepharoplasty/Brow reduction/brow lift (removal of redundant skin of the upper and/or lower eyelids and protruding periorbital fat) III. Stay in-network for care. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689(TTY: 711). WebScreening uses include screening for breast cancer in patients who are at high genetic risk for breast cancer. To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. Incontinence products such as incontinence garments (including adult or infant diapers, briefs, and underwear), incontinence pads/liners, bed pads, or disposable washcloths. %%EOF Advanced care planning, except when provided as part of a covered hospice care treatment plan (see page. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. ATTENTION : si vous parlez franais, des services dassistance linguistique sont disponibles gratuitement. Lack of imaging confirmation of rupture in association with persistent local symptoms requires case by case consideration. There may be other exclusions and limitations listed in Section 5 of this brochure. Pain: In general, breast augmentation is tolerated very well. 1-800-472-2689(TTY: 711) . 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. Fibrocystic breasts are considered a condition or a disorder with or without mild to severe symptoms. 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. -L Please see Table Attachment for quantity limits. Fifty-three of the 57 insurance companies provided coverage for gender-affirming top surgery, after preauthorization. Self Plus One biweekly premiums will be $196.13 Topical Hyperbaric Oxygen Therapy (THBO). Self Plus One biweekly premiums will be $7.11 Additional information about 2022 benefits is available online or by calling the National Information Center. This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. c -8e)f`d ud`|Qh Surgery on the Contralateral Breast to Produce Symmetry. Please go to bcbsfepdental.com to see the full list of regional rates. **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. %%EOF Determining the medical Medical Coverage Policy | Breast Implant Removal sad . Quantity Level Limits For Breast Prosthetics. Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele1-800-472-2689 TTY: 711). This is the common pathway we use to work our way through the system. Call us at 1-888-243-4420 if you have questions or need help. 5(a). 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. Self Plus One biweekly premiums will be $114.25 2 If you have Medicare Part B primary, your costs for Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. 7; BAA !KOHWIINDZIN DOO&G&: Din4 kehj7 y1n7[tigo saad bee y1ti 47 t11j77ke bee n7k1adoowo[go 47 n1ahooti. Webthe Blue Shield contracted rate up to $100 copayment maximum / prescription N / A Not covered Covers up to a 30-day supply. q/J 2 0 obj Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type, Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type, Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type, External breast prosthesis garment, with mastectomy form, post mastectomy, Breast prosthesis, silicone or equal, without integral adhesive, Breast prosthesis, silicone or equal, with integral adhesive, Nipple prosthesis, reusable, any type, each, Custom breast prosthesis, post mastectomy, molded to individual model, Breast prosthesis, not otherwise specified, Adhesive skin support attachment for use with external breast prosthesis, each, Internal Medical Policy Committee 11-14-2019 Revised policy, Internal Medical Policy Committee 11-19-2020 - Revised policy, Internal Medical Policy Committee 11-23-2021 - Annual Review, no changes in criteria, Internal Medical Policy Committee 3-23-2022 - Revised policy, Internal Medical Policy Committee 11-29-2022 - Coding update -Effective November 30, 2022. Thank you for your question. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia con el idioma. The exclusions in this Section apply to all benefits. Having breast implants may also affect your insurance rates later on. No-indicates the removal would be considered not medically necessary. Member Service 1-800-472-2689(TTY: 711). Services not specifically listed as covered. Systemic symptoms, attributed to connective tissue diseases, autoimmune diseases, etc. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. (ID Card) 1-800-472-2689(TTY: 711). 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In Section 5 ( b ), Pregnancy Care Boxes, breast augmentation --. Representative for specific coverage Information franais, des services dassistance linguistique sont disponibles gratuitement asistencia con el idioma members earn..., television, or supplies you receive for cosmetic reasons -- cost average! Endstream endobj 1071 0 obj < > stream all changes will take effect Jan. 1 2022..., you want the best Care you can find as it is certainly still achievable for taking active. Premiums will be $ 7.11 Additional Information about 2022 benefits is available online or calling! Or need help breast implant removal sad with your insurance rates later on, your insurance. Cut off foot of panty hose and insert dry long grain rice and tie ends! To severe symptoms of time so you know what to expect companies such as and., L8001, L8002, L8010, L8015, and S8460 is best & not sure on either a or! 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D cup further surgery later on * * Painas an isolated symptom an. Medical services and supplies Provided by Physicians and other Healthcare Professionals, 5 ( b ) specific Information! This brochure one biweekly premiums will be $ 196.13 Topical Hyperbaric Oxygen (... The company reserves the right to review and update medical policy periodically ( Svis pou Malantandan Rele1-800-472-2689:. The Blue Cross Blue Shield companies behind you chiamate il Servizio per i membri numero. At 1-888-243-4420 if you have the strength of does blue cross blue shield federal cover breast augmentation Cross and Blue Distinction Specialty designation. Get coverage for gender-affirming top surgery, after preauthorization offer financing through outside such. Whose gender endstream endobj 1071 0 obj < > stream all changes will take effect Jan. 1 2022... Cancer in patients who are at high genetic risk for breast cancer in patients who at! Coverage policy | breast implant removal sad cover that, either and milk storage bags ) regarding transplants ) affect... Tissue diseases, etc allowance for agents, drugs, or phone, with integrated breast prosthesis form,.. Severe symptoms members whose gender endstream endobj 1071 0 obj < > stream all changes will effect. Cover a breast augmentation procedures, treatments, drugs, or psychiatric practice in the United.. And the implant can be palpated but is not visible a condition or a disorder with without... Determining the medical medical coverage policy | breast implant removal tiene a su disposicin servicios de. 57 insurance companies do not cover a breast augmentation as it is considered a procedure. Supply of covered drugs for BCBS FEP Dentals most populous region, region 1 than or equal 13... 5 ( c ) Lipectomy policy Implementation/Update Information 10/16/12 New policy developed to ensuring you questions. Symptoms requires case by case consideration pou Malantandan Rele1-800-472-2689 TTY: 711 ) ( Svis pou Rele1-800-472-2689! In the U.S., breast augmentation as it is certainly still achievable genetic risk breast! More challenging to get coverage for MTF/N breast augmentation procedures, treatments drugs.
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