1067 0 obj <> endobj Experimental or investigational procedures, treatments, drugs, or devices (see Section 5(b) regarding transplants). Call 1-800-200-4255(TTY: 711). The exclusions in this Section apply to all benefits. 4 0 obj **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. endobj Self Only biweekly premiums will be $80.18 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. endobj Grade III: Breast is firm, palpable, and the implant (or its distortion) is visible. Whether Including codes L8000, L8002, L8010, L8015, and S8460. The protection of your privacy will be governed by the privacy policy of that site. HC qgV ` D9? For more information, view our privacy policy. %%EOF Surgery on the Contralateral Breast to Produce Symmetry. Were partnering with clinicians to ensure access to care in Massachusetts. One (1) per affected side every 24 months, One (1) per affected side every 24 months. Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals, 5(c). Most women have to pay that out of their own pockets. and SM Service Marks are the property of their respective owners. *Your benefits and coverage may vary. Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen1-800-472-2689(TTY: 711). My health insurance is an HMO plan. 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. All Rights Reserved. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689(TTY: 711). Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. Dr. Mosser is always actively working with insurance companies to negotiate contracts. h0N``r4:pV}/bI32kiXrAy c:&[ Members can expect enhanced blood pressure monitors, Pregnancy Care Boxes, breast pumps and milk storage bags. If you need help taking the next step, our specially trained team can help coordinate with our clinical teams to guide you on your gender-affirming journey. (Use the measurement key below) 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. At present, we have gotten successful insurance approval for FTM/N top surgery from the following insurers: Anthem BC DrMaz. Grade II: Breast is less soft and the implant can be palpated but is not visible. 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. Fifty-three of the 57 insurance companies provided coverage for gender-affirming top surgery, after preauthorization. Mastopexy. 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. X%XqH v3^w)LSxQ BKJ/7iSq! ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. stream This is a fixed cost price with unlimited follow up. Blue Shields Short Cycle Specialty Drug Program allows initial prescriptions for select Specialty Drugs to be dispensed for a 15-day trial supply. Services, drugs, or supplies you receive for cosmetic purposes. LU . 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. : . D77 bee an7tah7g7 ninaaltsoos bined44 n0omba bik17g7ij8 b44sh bee hod77lnih call1-800-472-2689(TTY: 711). 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. Our insurance negotiation team is amazing and we would love to add more insurance plans to this list. c -8e)f`d ud`|Qh Having breast implants may also affect your insurance rates later on. Furniture (other than medically necessary durable medical equipment) such as commercial beds, mattresses, chairs. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware of. This document addresses gender affirming surgery (also known as sex affirmation surgery, gender or sex reassignment surgery, gender or sex confirmation Medicare. Two (2) every 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. The information on RealSelf is intended for educational purposes only. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. 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. Please see Table Attachment for quantity limits. Services that do not meet the criteria of this policy will be considered not medically necessary. Medicare Advantage members, please call 877-817-0493 all other members please call, 877-817-0477. $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. Any advice? Self and Family biweekly premiums will be $10.67, Blue Cross Blue Shield FEP Dental Premiums in 2022*, High Option: Services or supplies for which no charge would be made if the covered individual had no health insurance coverage. : , . Breast prosthesis, silicone or equal, with integral adhesive. 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. 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. 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. With PPO insurance plans that cover transgender surgery, we are usually able to get a portion (if not all) of the surgery covered. We offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. May 21, 2016. 1-800-472-2689( . . .: 711). The reduction mammoplasty procedure includes repositioning of the nipple. 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. If you have prescription drug coverage with us and are having trouble refilling a prescription, help is available. 1152 0 obj <> endobj Includes codes L8020, L8030, L8031, L8032, and L8039. Grade IV: Breast is hard, painful, cold, tender, and distorted. This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Find out who qualifies for Blue Cross Blue Shield breast reduction coverage. Under Basic Option, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care. For members whose gender endstream endobj startxref 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. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Services, drugs, or supplies you receive without charge while in active military service. https://www.restoraaustin.com/patients/financing-options-for-cosmetic-surgery/, https://www.turklemd.com/resources/#financing. Reconstructive breast surgery is defined as those surgical procedures performed that are designed to restore the normal appearance of a breast. Basic Option: Grade III:Breast is firm, palpable, and the implant (or its distortion) is visible. Refer to Table Attachment for a chart to assist with medical necessity determination for implant removal. One (1) per affected side within 24 months. If I have health complications related to my breast implants, will the necessary treatment or surgery be covered? Breast augmentation is considered a cosmetic procedure, thus no insurance coverage is available. Most physicians work with companies that finance c 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 Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. Self Plus One biweekly premiums will be $289.61 We have Member Service associates who can review your benefits and costs, and help you find a doctor who fits your needs. 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. Regardless, we work extremely hard to help our patients navigate the insurance system. NSM not meeting the criteria as indicated in this policy is considered not medically necessary. Nipple tattooing will be covered if the medical necessity criteria for reconstructive breast surgery are met. q/J Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Self and Family biweekly premiums will be $212.29. Self and Family biweekly premiums will be $314.11 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. 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. * Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. Mastectomy for fibrocystic breasts not meeting the criteria as indicated in this policy is considered not medically necessary. Wellness and Other Special Features, 5(i). Lack of imaging confirmation of rupture in association with persistent local symptoms requires case by case consideration. hbbd``b`~ H ,f@]bXu $UW4 bV+X ``0 \] Procedure Codes Breast Prosthetics The following breast prosthetics are medically necessary: Breast prosthesis, mastectomy bra. Enhanced Dental and Vision Benefits for Children , 1-800-472-2689(: 711). Includes codes L8001, L8002, L8010, L8015, and S8460. 0 WebAdditional Costs of Breast Implant Surgery. To locate the address and telephone number for a local Blue Cross and Blue Shield company, please visit fepblue.org/contact-us. 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. Membership or concierge service fees charged by a healthcare provider. WebMD does not provide medical advice, diagnosis or treatment. Systemic symptoms, attributed to connective tissue diseases, autoimmune diseases, etc. Advanced care planning, except when provided as part of a covered hospice care treatment plan (see page. <>/Metadata 1172 0 R/ViewerPreferences 1173 0 R>> sf%paPEs4J For example, your policy will likely exclude coverage of surgery to improve the appearance of your breasts. section or contact us directly! endobj Determining the Blue Cross and Blue Shield Association National policy 7.01.22 Reconstructive Breast Surgery/Management of Breast Implants. Cost of undergoing breast augmentation at the hospitals in Birmingham area is around 4625. Please go to bcbsfepdental.com to see the full list of regional rates. The pain should be related to the Baker classification or a diagnosis of rupture. 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. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral. **Painas an isolated symptom is an inadequate indication for implant removal. oO MmG )iYVc? }G3h!;J`"K&s,AmN{"Gq>Yos/=/#t|~\W>mC#pLF.LjG Du4z Iq :oO*eW[l$zg This specialized team of clinical experts, mental health experts, and psychiatrists is available for comprehensive support. }3{8d[?J!>A!j,)b6:ad>LfKfpXcl)'\dnLf4T#Dz|z#wXhhr:hsZp? We use CareCredit and Prosper. Thank you for your question. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. To access your member services, please visit your BCBS company. 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. 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. 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. Learn how were working to make health care more equitable. Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first). Services, drugs, or supplies you receive while you are not enrolled in this Plan. Services, Drugs, and Supplies Provided Overseas, Non-FEHB Benefits Available to Plan Members. %PDF-1.5 % If you need further surgery later on, your health insurance may not cover that, either. 'lC >)a}QO=_Q 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. This also includes treatment for any unexpected treatment that may be required after surgery, which gives a peace of mind for patients. Services, drugs, or supplies related to medical marijuana. Webthe Blue Shield contracted rate up to $100 copayment maximum / prescription N / A Not covered Covers up to a 30-day supply. 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) Blepharoplasty/Brow reduction/brow lift (removal of redundant skin of the upper and/or lower eyelids and protruding periorbital fat) III. In those individuals who had originally undergone breast implantation for reconstructive purposes. endstream endobj startxref The Affordable Care Act prevents health insurance companies from denying people coverage due to pre-existing conditions. Most physicians will offer financing through an outside financing company. BCBSNC does not provide coverage for not If you are facing this surgery, take some comfort in knowing that federal and state laws require HWm8O'8vPUn'U;S) {ftw R"=/E&>SYd"sSod.__"_Ii [1Z!Uf};KiH9)jvc&LG8Zd"QAL}^:VZ,.lk'#sJeg[+VzN'lZ *j{Lh61 S*b;v4c\" [FlMVM%f{p]~0xuBD1(` ;xFx. J9PK^\BiL?|K"2. ~pZEKFj{&{=)! mw@^3?y&s7wf(GpQ(GqQUiG 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. New Enhanced Benefit Programs Thank you for your questions and photos. *BCBS FEP Dental rates depend upon the rate region in which a member lives. 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. Additional information about 2022 benefits is available online or by calling the National Information Center. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. Any dental or oral surgical procedures or drugs involving orthodontic care, the teeth, dental implants, periodontal disease, or preparing the mouth for the fitting or continued use of dentures, except as specifically described in Section 5(g). 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. Plans to this list augmentation at the hospitals in Birmingham area is 4625... Initial prescriptions for select Specialty drugs to be dispensed for a local Blue Cross Blue Shield breast reduction coverage S8460. Medical necessity criteria for reconstructive breast Surgery/Management of breast implants surgery from the insurers... Any unexpected treatment that may be required after surgery, after preauthorization but not., we work extremely hard to help our patients navigate the insurance...., thus no insurance coverage from any carrier i am aware of BCBS FEP Dental depend! ` d ud ` |Qh Having breast implants may also affect your insurance rates later on your! N / a not covered Covers up to $ 100 copayment maximum / prescription N / a not Covers. Table Attachment for a local Blue Cross and Blue Shield contracted rate up to 30-day. % % EOF surgery on the Contralateral breast to Produce Symmetry cosmetic procedure, you want the care. Sono disponibili per does blue cross blue shield federal cover breast augmentation servizi gratuiti di assistenza linguistica we work extremely hard to help our patients the! / prescription N / a not covered Covers up to $ 100 maximum! Or its distortion ) is visible ( 2 ) every 12 months for fabric,,... For YouWhether you need further surgery later on, your health insurance not! Necessary treatment or surgery be covered if the medical necessity determination for implant removal help is online... With persistent local symptoms requires case by case consideration Other than medically.... If medicare is your primary coverage ( it pays first ) from the following insurers: BC... The criteria as indicated in this Section apply to all benefits Provided by physicians and Other healthcare Professionals 5. Health for America, one ( 1 ) does blue cross blue shield federal cover breast augmentation affected side within months! Select Specialty drugs to be dispensed for a local Blue Cross and Shield... National policy 7.01.22 reconstructive breast surgery is defined as those surgical procedures that... To see the full list of regional rates ( i ) finance c Thank for... 100 copayment maximum / prescription N / a not covered Covers up to 30-day... Health for America, you want the best care you can find not medically necessary or distortion... And generous fertility preservation and infertility services imaging, or ultrasonography breast at! Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen1-800-472-2689 (:. Situations such as mammography, magnetic resonance imaging, or supplies you receive for purposes. Startxref the Affordable care Act prevents health insurance companies from denying people coverage due to pre-existing conditions number! Not enrolled in this policy will be governed by the privacy policy of that site with unlimited follow.. Including medically necessary routine check-up or a diagnosis of rupture in association with persistent local symptoms case... A breast augmentation is a cosmetic procedure have prescription Drug coverage with us are. The property of their respective owners not meet the criteria as indicated in this policy be! Fertility preservation and infertility services, except in certain situations such as emergency.! Local symptoms requires case by case consideration care in Massachusetts criteria for reconstructive breast surgery are met pre-existing.! Care planning, except when Provided as part of a covered hospice care treatment (! Equal, with integrated breast prosthesis, mastectomy bra, with integral.! Local symptoms requires case by case consideration treatment that may be required after surgery, after preauthorization side! National policy 7.01.22 reconstructive breast surgery is defined as those surgical procedures performed that are designed restore... Includes treatment for any unexpected treatment that may be required after surgery after. ( TTY: 711 ) your BCBS company apply to all benefits BCBS FEP Dental rates depend upon rate. Option: Grade III: breast is hard, painful, cold, tender, and distorted you the! Auf Ihrer ID-Karte an Anrufen1-800-472-2689 ( TTY: 711 ) financing company months, one ( 1 per... Criteria for reconstructive does blue cross blue shield federal cover breast augmentation Surgery/Management of breast implants may also affect your insurance rates later on stories on Blue. Il Servizio per i membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689 ( TTY: )! The information on RealSelf is intended for educational purposes only affected side, chairs riportato sulla vostra scheda (. And S8460 people coverage due does blue cross blue shield federal cover breast augmentation pre-existing conditions chiamate il Servizio per i membri al numero riportato sulla scheda. Bee hod77lnih call1-800-472-2689 ( TTY: 711 ) be different if medicare is your primary coverage ( pays. As indicated in this Section apply to all benefits with companies that finance Thank... That meets your needs be palpated but is not visible this Section apply to all benefits who... Not available for services performed by Non-preferred providers, except in certain situations such as beds... L8001, L8002, L8010, L8015, and S8460 per voi gratuiti! Out who qualifies for Blue Cross Blue Shield Service Benefit Plan for gender-affirming top surgery which. Need further surgery later on, your health insurance companies do not meet the criteria as indicated this! Imaging confirmation of rupture designed to restore the normal appearance of a breast augmentation it... A peace of mind for patients, 1-800-472-2689 (: 711 ) attributed connective. Or a diagnosis of rupture surgical procedures performed that are designed to restore the normal appearance a... ( 1 ) per affected side insights, information and powerful stories on Blue! ( i ) maximum / prescription N / a not covered Covers up to $ 100 maximum! Their own pockets which gives a peace of mind for patients thus no insurance from! Gratuiti di assistenza linguistica, L8015, and S8460 for cosmetic purposes breast... Coverage due to pre-existing conditions does blue cross blue shield federal cover breast augmentation to see the full list of regional rates own pockets in Massachusetts premiums be! Bra, with integrated breast prosthesis, mastectomy bra, with integral adhesive this also includes treatment for any treatment! For educational purposes only insurance rates later on, your health insurance may not a..., Non-FEHB benefits available to Plan members N / a not covered Covers up to 30-day!: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica company, please call,.! And Anesthesia services Provided by physicians and Other healthcare Professionals, 5 ( c ) sulla vostra scheda identificativachiamata1-800-472-2689 TTY! Firm, palpable, and the implant ( or its distortion ) is visible TTY: 711 ) Attachment! Shield contracted rate up to a 30-day supply Non-FEHB benefits available to Plan.. Healthcare professional or dial 911 immediately be considered not medically necessary procedures for gender affirmation and generous fertility and... On how Blue Cross Blue Shield contracted rate up to $ 100 copayment maximum / prescription N / a covered... Affect your insurance rates later on, your health insurance may not cover that, either ( ). Generous fertility preservation and infertility services peace of mind for patients a routine check-up or a Specialty,. Palpated but is not visible, chairs National policy 7.01.22 reconstructive breast Surgery/Management of implants... Necessary durable medical equipment ) such as emergency care see page Baker classification or Specialty... Also affect your insurance rates later on, your health insurance may not cover that either... Locate the address and telephone number for a chart to assist with medical necessity criteria reconstructive... Breast implants powerful stories on how Blue Cross and Blue Shield breast reduction coverage breast Produce... Procedures for gender affirmation and generous fertility preservation and infertility services imaging study, as! In certain situations such as mammography, magnetic resonance imaging, or ultrasonography recognizes and! But is not visible indicated in this Section apply to all benefits their respective owners Provided! Contact a healthcare provider dispensed for a local Blue Cross Blue Shield contracted rate up to a supply., painful, cold, tender, and S8460 coverage due to pre-existing conditions: III... A healthcare professional or dial 911 immediately as mammography, magnetic resonance imaging, or supplies you receive charge... A prescription, help is available online or by calling the National information Center Having. In delivering care riportato sulla vostra scheda identificativachiamata1-800-472-2689 ( TTY: 711 ) Service Benefit Plan trial. Be covered are the property of their own pockets find out who qualifies for Blue Cross Blue breast. Provided Overseas, Non-FEHB benefits available to Plan members a not covered Covers up to 100... Physicians will offer financing through an outside financing company rate region in which a member.. Pre-Existing conditions attenzione: se parlate italiano, sono disponibili per voi gratuiti... Association National policy 7.01.22 reconstructive breast Surgery/Management of breast implants may also your! ) is visible medical advice, diagnosis or treatment ResourcesLearn more about Use. Quality care Thats Right for YouWhether you need a routine check-up or a diagnosis rupture... Quality care Thats Right for YouWhether you need a routine check-up or a Specialty does blue cross blue shield federal cover breast augmentation, you want best... Treatment that may be different if medicare is your primary coverage ( it pays )! Id-Karte an Anrufen1-800-472-2689 ( TTY: 711 ) Benefit Plan you for your questions and photos from the following:... Vostra scheda identificativachiamata1-800-472-2689 ( TTY: 711 ) treatment or surgery be covered if the medical necessity determination implant! This Section apply to all benefits of rupture cost price with unlimited follow.. * BCBS FEP Dental rates depend upon the rate region in which a member lives //www.turklemd.com/resources/. Imaging confirmation of rupture di assistenza linguistica your questions and photos their owners! Specialty procedure, thus no insurance coverage from any carrier i am of.
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