If you need a breast reduction for medical or cosmetic reasons, you may be 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). Medicare. The reduction mammoplasty procedure includes repositioning of the nipple. However, health insurance companies can: SOURCES: Implant Information Project: "What You Need to Know Before You Get Breast Implants." With PPO insurance plans that cover transgender surgery, we are usually able to get a portion (if not all) of the surgery covered. **Painas an isolated symptom is an inadequate indication for implant removal. Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined in consultation with the attending physician and the individual. Some have been more receptive than others. Includes codes L8000, L8001, L8002, L8010, and L8015. 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! 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. ART-20203231. 1-800-472-2689(TTY: 711) . For information on obtaining prior approval for specific services, such as transplants, see Section 3, You need prior Plan approval for certain services. 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. PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. Includes codes L8030, L8031, L8032, L8035, and L8039. This information does not apply to members who have Medicaid or Medicare plans. Grade I:Augmented breast feels as soft as a normal breast. It will, though, cover breast implants for women who have had mastectomies due to breast cancer. For more information, view our privacy policy. **Painas an isolated symptom is an inadequate indication for implant removal. ! Milliman Care Guidelines (MCG) and the CMS Provider Reimbursement Manual. Were partnering with clinicians to ensure access to care in Massachusetts. %PDF-1.7 To access your member services, please visit your BCBS company. Self and Family biweekly premiums will be $10.67, Blue Cross Blue Shield FEP Dental Premiums in 2022*, High Option: 3 0 obj With enhanced benefits in all products in 2022, FEP continues its mission to provide unparalleled products and services to our members and their families.. Breast implants are prosthetic devices used to augment, reshape, and/or (or any amounts you desire). 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 Two (2) every 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. Our insurance negotiation team is amazing and we would love to add more insurance plans to this list. Breast augmentation is considered a cosmetic procedure, thus no insurance coverage is available. Most physicians work with companies that finance c Magnetic resonanceimaging (MRI) of the breast has been investigated Services not specifically listed as covered. 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. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. Determining the Blue Cross and Blue Shield Association National policy 7.01.22 Reconstructive Breast Surgery/Management of Breast Implants. Pain: In general, breast augmentation is tolerated very well. Incontinence products such as incontinence garments (including adult or infant diapers, briefs, and underwear), incontinence pads/liners, bed pads, or disposable washcloths. The information on RealSelf is intended for educational purposes only. Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele1-800-472-2689 TTY: 711). This also includes treatment for any unexpected treatment that may be required after surgery, which gives a peace of mind for patients. Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first). Adhesive skin support attachment for use with external breast prosthesis, each. This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Under Basic Option, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care. Limit your coverage. Surgery on the Contralateral Breast to Produce Symmetry. All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure. Generally, you must exhibit physical, objective symptoms to qualify. %PDF-1.7 % "03X2002$n0(Sh*lB4|P `vc Dear Geneseo,Thank you for your post. euIJ~rK?EWSML[!A`Hx-H"`x]74,%{WJ2hP'U0JAH 2 If you have Medicare Part B primary, your costs for Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. ` D9? 1zGzdQp26W&YJHO2pF(ug.`Fh$5XP>C!^DmSkp_J)^)6"Y/!r7s!J/\] }} f((x 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. WebReview the links below for information relevant to your coverage. Contracted insurance plans. DrMaz. 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. We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. Custom breast prosthesis, post mastectomy, molded to individual model. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Most physicians will offer financing through an outside financing company. If you have prescription drug coverage with us and are having trouble refilling a prescription, help is available. Two (2) within 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. The pain should be related to the Baker classification or a diagnosis of rupture. Step 1: Cut off foot of panty hose and insert dry long grain rice and tie the ends. 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. Lack of imaging confirmation of rupture in association with persistent local symptoms requires case by case consideration. 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 sf%paPEs4J ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstutzung zur Verfugung. Fibrocystic breasts are considered a condition or a disorder with or without mild to severe symptoms. The pain should be related to the Baker classification or a diagnosis of rupture. <> The benefits of coconut, argan, tea tree and more. Services, Drugs, and Supplies Provided Overseas, Non-FEHB Benefits Available to Plan Members. You can also visit our Mental Health Resource Center to learn more. Please see your subscriber certificate for details about your plan coverage. Grade II:Breast is less soft and the implant can be palpated but is not visible. (Use the measurement key below) Please review the terms of use and privacy policies of the new site you will be visiting. Blue Cross Blue Shield FEP Vision Premiums in 2022: High Option: Self Plus One biweekly premiums will be $289.61 %8eRq xq{2cQ'YzRh(KE&WNO-ID.}16m', ~D[+d\q~0}h(U~LG 1ek[FZOvM) .P=xgu`E)I M p_]pV#g$ RkPGV9& G{(TRp. Find out who qualifies for Blue Cross Blue Shield breast reduction coverage. : , . Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. One (1) per affected side within 24 months. Additional sources are used and can be provided 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. Quantity Level Limits For Breast Prosthetics. Thank you for your question. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. Procedure Codes Breast Prosthetics The following breast prosthetics are medically necessary: Breast prosthesis, mastectomy bra. Insurance usually will not cover breast enlargement surgery. Federal employees, annuitants and their family members are eligible for coverage through the FEHB Program, while FEDVIP is available to federal employees and annuitants, certain retired uniformed service members and active duty family members. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. : , . Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral. Mental Health and Substance Use Disorder Benefits, 5(h). %vH>jJ(BS+4t|!vLSM z7&^\&gN;ObtGn=M&qbn' IL\] #5!qgu02>/qdV&JUNeHyYYQD-LKR(=#s!R{@*^Gg&lrGAegn[R-{.{/om?DiQiH9e1A Includes codes L8020, L8030, L8031, L8032, and L8035. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Grade IV: Breast is hard, painful, cold, tender, and distorted. Appelez le Service adhrents au numro indiqu sur votre carte dassur appel1-800-472-2689 (TTY : 711). Sincerely, a mommy in need of a miracle. Eligible participants will have an opportunity to make their coverage decisions during Open Season, which runs from Nov. 8 through Dec. 13, 2021. There are lots of implant options out there. The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. The Affordable Care Act prevents health insurance companies from denying people coverage due to pre-existing conditions. Grade II: Breast is less soft and the implant can be palpated but is not visible. Services, drugs, or supplies you receive while you are not enrolled in this Plan. $30 copayfor primary care1 Sometimes, we can even pave the way to get a contract between your insurance company and our office so that future patients who have the same insurance can benefit as well. Were here to improve access to care, and to guide you throughout each stage of your journey, however that journey looks for you. Removal of implants requires documentation of the original indication for implantation and the type of implant, either saline- or silicone gel-filled, and the current symptoms, either local or systemic. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral. Thank you for your questions and photos. Insurance companies do not cover this surgery because it's "cosmetic " in nature, they do cover breast rec We have Member Service associates who can review your benefits and costs, and help you find a doctor who fits your needs. As we continue to navigate an unprecedented health crisis, Blue Cross Blue Shield FEP health, dental and vision members know they can count on us to make sure affordable and comprehensive health care is accessible no matter where they are, said William A. Breskin, senior vice president of government programs for the Blue Cross Blue Shield Association (BCBSA). All rights reserved. One (1) per affected side every three (3) months. HZjz:|QkM]h]\ oO MmG )iYVc? }G3h!;J`"K&s,AmN{"Gq>Yos/=/#t|~\W>mC#pLF.LjG Du4z Iq :oO*eW[l$zg Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689(TTY: 711). 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 If you need further surgery later on, your health insurance may not cover that, either. Services, drugs, or supplies related to medical marijuana. Lumpectomy is the removal of the breast tumor and surrounding tissue. *dlVU! For instance, some insurers won't cover diseases of the breast - including breast cancer -- if you have breast implants. Most surgeons do offer financing through outside companies such as Care credit for example. : , , : .. Self and Family biweekly premiums will be $212.29. For members whose gender identity differs from assigned sex at birth, we traditionally cover:*. Suite 1000, 450 Sutter St San Francisco, CA 94108, Introduction to FTM, FTN, MTF and MTN Top Surgery. Only in those individuals who had originally undergone breast implantation for reconstructive purposes. National Research Center for Women and Families: "What You Need to Know about Breast Implants." 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. Mastectomy for fibrocystic breasts not meeting the criteria as indicated in this policy is considered not medically necessary. At present, we have gotten successful insurance approval for FTM/N top surgery from the following insurers: Anthem BC Includes codes L8000, L8001, L8002, L8010, and S8460. ID 1-800-472-2689TTY 711). : Nu quy v n.i Ting Vit, c.c dch v h tr ng.n ng c cung cp cho quy v min ph.. Gi cho Dch v Hi vi.n theo s tr.n th ID ca quy v Cuc gi 1-800-472-2689(TTY: 711). 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. 2023 Blue Cross Blue Shield Association. Complications of breast implants are common and may require removal of the implant. Reconstructive breast surgery is defined as those surgical procedures performed that are designed to restore the normal appearance of a breast. FEP Blue Focus: 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. However many plastic surgeons EUmsCd}]'`d w! M q/J Includes codes L8000, L8001, L8010, L8015, and S8460. ATANSYON: Si ou pale kreyl ayisyen, svis asistans nan lang disponib pou ou gratis. 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. x]s6=3x;Lin4{ #Hs A $Yr"Sv]'66M1eyES-|KY]x~sg*_;69"vsY?Y3?{w5L?&`~^/I?YdPdZ8b\ Member Discounts Take advantage of member-only discounts on health-related products and services. Breast prosthesis, silicone or equal, with integral adhesive. endobj Augmentation changes the size and appearance of one or both breasts by transferring body fat to them or adding artificial implants. Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. Check out the changes and updates to our plan in 2023. External breast prosthesis garment, with mastectomy form, post mastectomy. Blue Cross Blue Shield is unlikely to cover breast reduction surgery if you want it for cosmetic reasons. Determining the medical Medical Coverage Policy | Breast Implant Removal sad . 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. If you do not see your insurer on this list, please contact us. Self Only biweekly premiums will be $127.47 Other insurance types such as disability insurance, motor vehicle insurance, prescription card plans and workers' compensation. Dr. Mosser is always actively working with insurance companies to negotiate contracts. In those individuals who had originally undergone breast implantation for reconstructive purposes. endobj Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag1-800-472-2689(TTY: 711). Llame al nmero de Servicio al Cliente que figura en su tarjeta de identificacin llamada1-800-472-2689 (TTY: 711). Nipple prosthesis, reusable, any type, each. 1152 0 obj <> endobj We use cookies on this website to give you the best experience and measure website usage. %%EOF Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware of. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. hb```@(1atZ Qr)aFKyi]8>I_13 huv1v.<4zz"@lfYXl}qjRX*:;+:;:;:LQ f I don't know if silicone or saline is best & not sure on either a C or D cup. I. D77 bee an7tah7g7 ninaaltsoos bined44 n0omba bik17g7ij8 b44sh bee hod77lnih call1-800-472-2689(TTY: 711). Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. FEP Blue Focus premiums remain flat for fourth consecutive year, Blue Cross and Blue Shield Federal Employee Program (FEP) Introduces Enhanced Hypertension and Pregnancy Programs, Dental and Vision Benefits and New International Travel Insurance, Blue Cross Blue Shield Companies Form Synergie Medication Collective, a New Venture to Radically Improve Affordability and Access to Costly Medications for Millions of Americans, Congress Passes Meaningful Changes to Expand Mental Health Support, Improve Maternal Health, and Lower Costs for Consumers, Blue Cross Blue Shield Association Enhances Blue Distinction Centers for Maternity Care Criteria to Advance Health Equity, New Study: No Surprises Act Protects 9 Million Americans from Surprise Medical Bills, Blue Cross Blue Shield Association Statement on the Election of the 118th Congress, Blue Cross and Blue Shield of Louisiana Offers Services to Members Affected by Hurricane Ida, Blue Cross Of Idaho And The Blue Cross Of Idaho Foundation For Health Commit To Expanding Health Equity Across Idaho, Blue Cross Blue Shield of Wyoming Announces New Board Member, James G. Springfield Named President of Blue Cross and Blue Shield of Texas. The exclusions in this Section apply to all benefits. Members can expect enhanced blood pressure monitors, Pregnancy Care Boxes, breast pumps and milk storage bags. Self Plus One biweekly premiums will be $7.11 Experimental or investigational procedures, treatments, drugs, or devices (see Section 5(b) regarding transplants). Topical Hyperbaric Oxygen Therapy (THBO). BAA !KOHWIINDZIN DOO&G&: Din4 kehj7 y1n7[tigo saad bee y1ti 47 t11j77ke bee n7k1adoowo[go 47 n1ahooti. ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. Two companies provided coverage on a case-by case basis; one Breast prosthesis, not otherwise specified. Self Only biweekly premiums will be $9.22 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. Recreational or educational therapy, and any related diagnostic testing, except as provided by a hospital during a covered inpatient stay. Lack of imaging confirmation of rupture in association with persistent local symptoms requires case by case consideration. New Supplemental International Travel Insurance 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). This is the common pathway we use to work our way through the system. 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. %%EOF hb```,RQ *Your benefits and coverage may vary. % Self Plus One biweekly premiums will be $196.13 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.
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