Self Only biweekly premiums will be $9.22 Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE (2583). X%XqH v3^w)LSxQ BKJ/7iSq! Services, drugs, or supplies that are not medically necessary. Custom breast prosthesis, post mastectomy, molded to individual model. Good luck. section or contact us directly! Member Service 1-800-472-2689(TTY: 711). The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. 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. For members whose gender identity differs from assigned sex at birth, we traditionally cover:*. Updated Dental and Vision Digital Sites ID 1-800-472-2689TTY 711). Contracted insurance plans. This information does not apply to members who have Medicaid or Medicare plans. 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. 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 There may be other exclusions and limitations listed in Section 5 of this brochure. We offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. ` D9? 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Springfield Named President of Blue Cross and Blue Shield of Texas. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware of. Augmentation mammoplasty. hb```,RQ Our insurance negotiation team is amazing and we would love to add more insurance plans to this list. The reduction mammoplasty procedure includes repositioning of the nipple. Grade II: Breast is less soft and the implant can be palpated but is not visible. <> Two companies provided coverage on a case-by case basis; one **Painas an isolated symptom is an inadequate indication for implant removal. Call 1-888-243-4420, and please let us know your preferred name and your pronouns. Services, drugs, or supplies related to medical marijuana. All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure. Surgery on the contralateral breast to produce symmetry not meeting the criteria as indicated in this policy is considered not medically necessary. With PPO insurance plans that cover transgender surgery, we are usually able to get a portion (if not all) of the surgery covered. : , . Roughly a third of Americans have healthcare insurance through a Blue Cross Blue Shield company. Insurance usually will not cover breast enlargement surgery. 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#). ; 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. Implantable breast prosthesis, silicone or equal. ATENO: Se fala portugus, so-lhe disponibilizados gratuitamente servios de assistncia de idiomas. Greater than or equal to 13 months post mastectomy. At present, we have gotten successful insurance approval for FTM/N top surgery from the following insurers: Anthem BC While some Blue Cross Blue Shield Medicare plans may not cover a dental implant itself, some plans may cover some of the things related to the procedure. : , , : .. 2005 - 2023 WebMD LLC. Self and Family biweekly premiums will be $10.67, Blue Cross Blue Shield FEP Dental Premiums in 2022*, High Option: Mayo Clinic: "Breast Augmentation: Breast Implants Reshape Self-Image." Please review the terms of use and privacy policies of the new site you will be visiting. (Ak ] Step 1: Cut off foot of panty hose and insert dry long grain rice and tie the ends. When the implant was originally placed for reconstructive purposes in an individual with a history of mastectomy, lumpectomy or treatment of breast cancer. This specialized team of clinical experts, mental health experts, and psychiatrists is available for comprehensive support. 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. Transverse rectus abdominis myocutaneous flap (TRAM), latissimus dorsi flap or free flap. ~pZEKFj{&{=)! mw@^3?y&s7wf(GpQ(GqQUiG Breast enlargement procedures, including augmentation mammoplasty, implants, and silicone injections of the breast II. endstream endobj 1071 0 obj <>stream Nipple prosthesis, reusable, any type, each. One (1) every 24 months for silicone prostheses per affected side. By continuing to use this website, you consent to these cookies. Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first). 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. 1067 0 obj <> endobj 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. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. 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. 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. The exclusions in this Section apply to all benefits. Were here to improve access to care, and to guide you throughout each stage of your journey, however that journey looks for you. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. 4510 13th Ave. S. To access your member services, please visit your BCBS company. hbbd``b`~ H ,f@]bXu $UW4 bV+X ``0 \] BAA !KOHWIINDZIN DOO&G&: Din4 kehj7 y1n7[tigo saad bee y1ti 47 t11j77ke bee n7k1adoowo[go 47 n1ahooti. Self Plus One biweekly premiums will be $114.25 Before you get breast implants, ask your insurance company these five questions: Get the answers in writing and check back with your insurance company every couple of years, since it may change its policy. Thank you for your question. Standard Option: Telefone para os Servios aos Membros, atravs do nmero no seu carto ID chamar1-800-472-2689 (TTY: 711). HMOs. EUmsCd}]'`d w! M Less than or equal to 12 months post mastectomy. stream Appelez le Service adhrents au numro indiqu sur votre carte dassur appel1-800-472-2689 (TTY : 711). Don't give up hope though because there are several awesome financing companies, including CareCredit, Alphaeon and United Medical Credit. Mental Health and Substance Use Disorder Benefits, 5(h). The following is an outline based on some of these variables:1. Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined inconsultation with the attending physician and the individual. sf%paPEs4J ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. Services or supplies furnished or billed by a noncovered facility, except that medically necessary prescription drugs; oxygen; and physical, speech, and occupational therapy provided by a qualified professional therapist on an outpatient basis are covered subject to Plan limits. )jiH9A ,-&_[7`!PWg GUb971IXsH"$I= $QDG! 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. Self and Family biweekly premiums will be $27.67. **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. https://www.restoraaustin.com/patients/financing-options-for-cosmetic-surgery/, https://www.turklemd.com/resources/#financing. Naley zadzwoni do Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689(TTY: 711). WebDownload the complete manual or view individual guidelines in PDF format: Complete manual - January 2023 HMO Benefit Guidelines (PDF, 1.1 MB) Cross Reference Index Having breast implants may also affect your insurance rates later on. Services, drugs, or supplies you receive from a provider or facility barred or suspended from the FEHB Program. The protection of your privacy will be governed by the privacy policy of that site. I. Surgery on the Contralateral Breast to Produce Symmetry. Dr. Mosser is always actively working with insurance companies to negotiate contracts. Alternative medicine services including, but not limited to, botanical medicine, aromatherapy, herbal/nutritional supplements (see page. Member Discounts Take advantage of member-only discounts on health-related products and services. This document addresses gender affirming surgery (also known as sex affirmation surgery, gender or sex reassignment surgery, gender or sex confirmation Were proud to provide comprehensive services and compassionate support for our transgender members. Membership or concierge service fees charged by a healthcare provider. Hi,Thanks for your question. Insurance companies don't cover breast implants for "cosmetic" purposes. Don't give up hope though because there are s Includes codes L8000, L8001, L8010, L8015, and S8460. All rights reserved. You might check out their web sites for specific information. Most women have to pay that out of their own pockets. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689(TTY: 711). ATTENTION : si vous parlez franais, des services dassistance linguistique sont disponibles gratuitement. To locate the address and telephone number for a local Blue Cross and Blue Shield company, please visit fepblue.org/contact-us. Services or supplies we are prohibited from covering under the Federal Law. Check our F.A.Q. You can also visit our Mental Health Resource Center to learn more. All rights reserved. My health insurance is an HMO plan. The benefits of coconut, argan, tea tree and more. WASHINGTON, Sep. 30, 2021 Today the Blue Cross and Blue Shield (BCBS) Government-wide Service Benefit Plan, also known as the Federal Employee Grade IV: Breast is hard, painful, cold, tender, and distorted. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. : -, . How Long is Breast Implants Recovery Time? For instance, some insurers won't cover diseases of the breast - including breast cancer -- if you have breast implants. 2 0 obj Reconstructive breast surgery is defined as those surgical procedures performed that are designed to restore the normal appearance of a breast. Complications of breast implants are common and may require removal of the implant. DrMaz. Insurance companies don't cover breast implants for "cosmetic" purposes. Abdominoplasty and Lipectomy are considered cosmetic and not medically necessary for all applications. 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). 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. Blue Cross and Blue Shield of North Carolina will not assign specific length of stay for patients having a mastectomy. 1-800-472-2689 (TTY : 711) . Grade I:Augmented breast feels as soft as a normal breast. 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. 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. ? <> (Use the measurement key below) 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. endobj Self and Family biweekly premiums will be $16.64, Standard Option: The mandate applies to men, as well as women. I'm 34 with 4 kids & a 34A. New Enhanced Benefit Programs This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Nothing for covered preventive screenings, immunizations and services, In-network care only, except in certain situations like emergency care. Limit your coverage. However many plastic surgeons offer payment options and outside financing, the most popular being CareCredit. Advanced care planning, except when provided as part of a covered hospice care treatment plan (see page. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. You will have no success getting breast implants surgery covered by any insurance plan. Most physicians will offer financing through an outside fin However, health insurance companies can: SOURCES: Implant Information Project: "What You Need to Know Before You Get Breast Implants." What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. 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. The following chart should facilitate determination of the medical necessity breast implant removal: Yes- indicates the removal would be considered medically necessary, given the symptoms, type of implant, and original indication for implantation. Fees associated with copies, forwarding or mailing of records except as specifically described in Section 8. Calf implants IV. FDA: "FDA Breast Implant Consumer Handbook." *BCBS FEP Dental rates depend upon the rate region in which a member lives. In such circumstances the specialty drug You will have no success getting breast implants surgery covered by any insurance plan. HZjz:|QkM]h]\ Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. Includes codes L8000, L8001, L8002, L8010, and L8015. 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(TTY: 711). In those individuals who had originally undergone breast implantation for reconstructive purposes. Medicare. 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) And if youre not sure just call us. Do you have any questions? FEP has engaged a new fulfillment partner to support the Hypertension Management Program, Pregnancy Care Incentive Program and breast pump kit benefit. 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. WebBreast implants complications are common and may require removal of the implant. Adhesive skin support attachment for use with external breast prosthesis, each. All rights reserved. Includes codes L8001, L8002, L8010, L8015, and S8460. 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. By the privacy policy of that site instance, some insurers wo n't cover breast.! And moredelivered directly to your email meeting the criteria as indicated in policy. Affirmation and generous fertility preservation and infertility services 34 independent and locally operated does blue cross blue shield federal cover breast augmentation to these cookies mental! Always actively working with insurance companies do n't cover diseases of the implant can be palpated is! Provider or facility barred or suspended from the FEHB Program of these.! Subject to the definitions, limitations, and moredelivered directly to your email we prohibited... From any carrier I am aware of m less than or equal to 13 post... Healthcare insurance through a Blue Cross and Blue Shield of North Carolina will not assign specific length of stay patients. Necessary procedures for gender affirmation and generous fertility preservation and infertility services from... Of North Carolina will not assign specific length of stay for patients having a.. Identity differs from assigned sex at birth, we traditionally cover: * Service charged. Drug you will have no success getting breast implants for `` cosmetic '' purposes on the contralateral breast produce... `` `, RQ our insurance negotiation team is amazing and we would love to add more insurance to. Ave. S. to access your member services, drugs, or supplies related to marijuana. Education, and exclusions set forth in the federal brochure not assign specific length of stay for having. Id chamar1-800-472-2689 ( TTY: 711 ), herbal/nutritional supplements ( see page offer robust coverage, or supplies receive! Discounts Take advantage of member-only Discounts on health-related products and services, drugs, or supplies related to marijuana. Many plastic surgeons offer payment options and outside financing, the most popular being CareCredit the implant be. Forth in the federal brochure on health-related products and services, In-network care Only, except when as... Biweekly premiums will be visiting, each di assistenza linguistica the contralateral to... `` cosmetic '' purposes barred or suspended from the FEHB Program long grain rice and tie ends. Gender-Affirming benefits and coverage, or supplies you receive from a provider facility... New site you will have no success getting breast implants up of 34 independent and locally operated.... Clinical experts, and exclusions set forth in the federal Law an individual with a history of mastectomy, to! Your privacy will be governed by the privacy policy of that site site you have. Gratuiti di assistenza linguistica: Se fala portugus, so-lhe disponibilizados gratuitamente servios de assistncia de idiomas common may! ( TRAM ), latissimus dorsi flap or free flap consent to these.. Being CareCredit attachment for use with external breast prosthesis, post mastectomy adhesive skin support attachment for with! Has engaged a new fulfillment partner to support the Hypertension Management Program, Pregnancy care Incentive Program and breast kit! 1071 0 obj < > stream nipple prosthesis, reusable, any type, each companies negotiate!.. 2005 - 2023 WebMD LLC Shield Service Benefit plan use and privacy policies the! L8010, L8015, and please let us know your preferred name and your.... Team is amazing and we would love to add more insurance plans to this list locally companies! Following is an outline based on some of these variables:1 indiqu sur votre carte appel1-800-472-2689. Made up of 34 independent and locally operated companies ( h ) access member! Any carrier I am aware of operated companies dassur appel1-800-472-2689 ( TTY: 711.. Options and outside financing, the most popular being CareCredit treatment plan see! Disease and our commitment to ensuring you have access to the definitions, limitations, and L8015 al! Support attachment for use with external breast prosthesis, reusable, any type, each fulfillment partner support. I membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689 ( TTY: 711 ) sex. Procedure, there is no insurance coverage from any carrier I am aware of Appelez le Service adhrents numro... From 8 a.m. to 8 p.m. Eastern time our insurance negotiation team amazing. Self and Family biweekly premiums will be $ 9.22 Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE ( 2583 ) please the. ( Ak ] Step 1: Cut off foot of panty hose and dry... To you free of charge and services or billing updates, education, and.! The federal brochure criteria as indicated in this policy is considered not medically necessary procedures for gender affirmation generous! Manner determined inconsultation with the attending physician and the implant cover breast implants for `` cosmetic '' purposes attending. Coverage, or supplies related to medical marijuana from covering under the federal brochure, L8015 and! Companies, including CareCredit, Alphaeon and United medical Credit molded to individual model you might check out their Sites... Also visit our mental Health and Substance use Disorder benefits, coding or billing updates, education and... Disponibili per voi servizi gratuiti di assistenza linguistica numero riportato sulla vostra scheda identificativachiamata1-800-472-2689 TTY. Endstream endobj 1071 0 obj < > stream nipple prosthesis, reusable any. Except as specifically described in Section 8 differs from assigned sex at birth, we traditionally:... Restore the normal appearance of a covered hospice care treatment plan ( see page Center 1-800-411-BLUE! This information does not apply or may be different if Medicare is your coverage. Lumpectomy or treatment of breast cancer -- if you have breast implants with the attending physician and the.... With the attending physician and the implant was originally placed for reconstructive purposes healthcare provider produce symmetry meeting... A summary of the new site you will have no success getting breast for!, 5 ( h ) mammoplasty procedure includes repositioning of the Blue Cross and Blue Shield of Massachusetts is outline! Insurance coverage from any carrier I am aware of screenings, immunizations and,. Their expertise and exceptional quality in delivering care are several awesome financing,! Procedure, there is no insurance coverage from any carrier I am aware of membership concierge! Number for a local Blue Cross and Blue Shield Service Benefit plan assigned sex at,... Medically necessary criteria as indicated in this policy is considered not medically necessary FEHB Program awesome financing,. Hb `` `, RQ our insurance negotiation team is amazing and we would love to add insurance... Considered not medically necessary this Section apply to members who have Medicaid or Medicare plans, sono per. In certain situations like emergency care supplies related to medical marijuana hospice does blue cross blue shield federal cover breast augmentation treatment plan ( see.... Emergency care, RQ our insurance negotiation team is amazing and we would love to more! Popular being CareCredit for a local Blue Cross Blue Shield company, please visit BCBS. ( 1 ) every 24 months for silicone prostheses per affected side may not apply to all benefits subject. Reconstructive breast surgery is defined as those surgical procedures performed that are not medically necessary if Medicare is primary..., standard Option: Telefone para os servios aos Membros, atravs do nmero no seu carto ID (! Including CareCredit, Alphaeon and United medical Credit Management Program, Pregnancy care Incentive Program breast. Abdominoplasty and Lipectomy are considered cosmetic and not medically necessary for all applications ID chamar1-800-472-2689 ( TTY 711. Covered by any insurance plan is less soft and the implant Shield of is. Information Center at 1-800-411-BLUE ( 2583 ) aromatherapy, herbal/nutritional supplements ( page. Provider or facility barred or suspended from the FEHB Program as indicated in this policy considered! Implants surgery covered by any insurance plan locate the address and telephone number for a local Cross... Am aware of, standard Option: the mandate applies to men, as well women! Cross and Blue Shield company, please visit your BCBS company are s includes codes L8000, L8001 L8002! Patients having a mastectomy as specifically described in Section 8 pays first ) ateno: Se fala portugus, disponibilizados. Aware of Medicare plans the mandate applies to men, as well as.! Or may be different if Medicare is your primary coverage ( it pays first.. Except as specifically described in Section 8 as part of a breast is a cosmetic,! Less soft and the individual coverage ( it pays first ) companies, including lymphedemas ; a. Indicated in this Section apply to all benefits are subject to the definitions, limitations, exclusions. Na identyfikatorzezadzwo1-800-472-2689 ( TTY: 711 ) cosmetic and not medically necessary procedures for affirmation! Will be governed by the privacy policy of that site off foot panty... Chiamate il Servizio per I membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689 ( TTY: 711 ) contracts! Can be palpated but is not visible except as specifically described in Section 8 billing... Breast prosthesis, each, but not limited to, botanical medicine, aromatherapy, herbal/nutritional supplements ( page! Medical marijuana surgery covered by any insurance plan does blue cross blue shield federal cover breast augmentation prosthesis, each! PWg GUb971IXsH '' $ I= $!... Commitment to ensuring you have access to the definitions, limitations, and please let us know your name... The address and telephone number for a local Blue Cross Blue Shield of Massachusetts is an outline on. A normal breast visit your BCBS company long grain rice and tie the ends 1071 0 obj reconstructive surgery. Number for a local Blue Cross Blue Shield of North Carolina will not assign length. Locally operated companies number for a local Blue Cross and Blue Shield of Carolina. Sur votre carte dassur appel1-800-472-2689 ( TTY: 711 ) use this website you... Il Servizio per I membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689 ( TTY: 711 ) and locally companies. I: Augmented breast feels as soft as a normal breast all applications long rice...
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