Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined inconsultation with the attending physician and the individual. 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. : , . Pain: In general, breast augmentation is tolerated very well. ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstutzung zur Verfugung. *Your benefits and coverage may vary. Were here to improve access to care, and to guide you throughout each stage of your journey, however that journey looks for you. 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. 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. Mastectomy for fibrocystic breasts not meeting the criteria as indicated in this policy is considered not medically necessary. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Two companies provided coverage on a case-by case basis; one : , , . Mastopexy. %%EOF
To locate the address and telephone number for a local Blue Cross and Blue Shield company, please visit fepblue.org/contact-us. Transverse rectus abdominis myocutaneous flap (TRAM), latissimus dorsi flap or free flap. Calf implants IV. x]s6=3x;Lin4{
#Hs A $Yr"Sv]'66M1eyES-|KY]x~sg*_;69"vsY?Y3?{w5L?&`~^/I?YdPdZ8b\ 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. 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 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. There may be other exclusions and limitations listed in Section 5 of this brochure. Ask your health insurance company ahead of time so you know what to expect. 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 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 Services, drugs, or supplies not required according to accepted standards of medical, dental, or psychiatric practice in the United States. 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. This is the common pathway we use to work our way through the system. Lack of imaging confirmation of rupture in association with persistent local symptoms requires case by case consideration. 1 0 obj
However many plastic surgeons UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. WebAdditional Costs of Breast Implant Surgery. Reduction mammoplasty. The Affordable Care Act prevents health insurance companies from denying people coverage due to pre-existing conditions. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689(TTY: 711). The protection of your privacy will be governed by the privacy policy of that site. Advanced care planning, except when provided as part of a covered hospice care treatment plan (see page. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral. ~pZEKFj{&{=)!
mw@^3?y&s7wf(GpQ(GqQUiG Includes codes L8030, L8031, L8032, L8035, and L8039. Web1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. Greater than or equal to 13 months post mastectomy. Please call 1-888-243-4420 for more information. Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). 1197 0 obj
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Surgery* on the contralateral breast to produce a symmetrical appearance after removal of an implant and reimplantation may be considered reconstructive and medically necessary: * Types of reconstructive surgical procedures on the diseased breast include, but are not limited to: 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. Abdominoplasty and Lipectomy are considered cosmetic and not medically necessary for all applications. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Nipple tattooing will be covered if the medical necessity criteria for reconstructive breast surgery are met. 'lC
>)a}QO=_Q Includes codes L8001, L8002, L8010, L8015, and S8460. Two (2) within 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. Among the changes include enhanced hypertension management and pregnancy care incentive programs, dental and vision benefits for children and the addition of a discounted supplemental international travel insurance through GeoBlue. Is there a rule of thumb or tips for choosing breast augmentation sizes? Please go to bcbsfepdental.com to see the full list of regional rates. 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. . 2020 Blue Cross Blue Shield Association. ***Contractureshave been graded according to the Baker Classification which is outlined below: Grade I: Augmented breast feels as soft as a normal breast. 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). . -L You might check out their web sites for specific information. I don't know if silicone or saline is best & not sure on either a C or D cup. For some reason, FTM/N chest reconstruction has had a better reception within some insurance programs for approval. Grade I:Augmented breast feels as soft as a normal breast. endstream
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<. 1-800-472-2689(TTY: 711) . WebSection V-Surgical Management of Breast Implants. Suite 1000, 450 Sutter St San Francisco, CA 94108, Introduction to FTM, FTN, MTF and MTN Top Surgery. Telefone para os Servios aos Membros, atravs do nmero no seu carto ID chamar1-800-472-2689 (TTY: 711). Wellness and Other Special Features, 5(i). 1152 0 obj
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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. Orthodontic care for malposition of the bones of the jaw or for temporomandibular joint (TMJ) syndrome.
X%XqH v3^w)LSxQ BKJ/7iSq! 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. 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). Two (2) every 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. 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. 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. : . 1170 0 obj
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Mayo Clinic: "Breast Augmentation: Breast Implants Reshape Self-Image." Insurance companies do not cover this surgery because it's "cosmetic " in nature, they do cover breast reconstruction after breastcancer surgery. Medicare Advantage members, please call 877-817-0493 all other members please call, 877-817-0477. In most practices, including ours, financing programs are available. Self Plus One biweekly premiums will be $196.13 In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including surgeon's fees, operating room costs and anesthesia)in 2022. ^What youll pay for a 30-day supply of covered drugs. hbbd``b`~ H ,f@]bXu $UW4 bV+X ``0 \]
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. However many plastic surgeons offer payment options and outside financing, the most popular being CareCredit. D77 bee an7tah7g7 ninaaltsoos bined44 n0omba bik17g7ij8 b44sh bee hod77lnih call1-800-472-2689(TTY: 711). Self Plus One biweekly premiums will be $289.61 1-800-472-2689(TTY: 711). Hi,Thanks for your question. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral. Services, Drugs, and Supplies Provided Overseas, Non-FEHB Benefits Available to Plan Members. Self Plus One biweekly premiums will be $36.11 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. 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. For members whose gender Most surgeons do offer financing through outside companies such as Care credit for example. Fees associated with copies, forwarding or mailing of records except as specifically described in Section 8. %PDF-1.7
Services, drugs, or supplies you receive for cosmetic purposes. Including codes L8000, L8002, L8010, L8015, and S8460. WebBreast implants complications are common and may require removal of the implant. Breast implants are prosthetic devices used to augment, reshape, and/or Contracted insurance plans. Self Only biweekly premiums will be $53.14 If you are facing this surgery, take some comfort in knowing that federal and state laws require Grade III:Breast is firm, palpable, and the implant (or its distortion) is visible. ID 1-800-472-2689TTY 711). Self Only biweekly premiums will be $18.05 Good luck. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. 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. 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. Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. * Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. May 21, 2016. Blue Cross and Blue Shield of North Carolina will not assign specific length of stay for patients having a mastectomy. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. : -, . Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen1-800-472-2689(TTY: 711). Custom breast prosthesis, post mastectomy, molded to individual model. : , . Most physicians will offer financing through an outside financing company. 1089 0 obj
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If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. 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). Augmentation changes the size and appearance of one or both breasts by transferring body fat to them or adding artificial implants. Fibrocystic breasts are considered a condition or a disorder with or without mild to severe symptoms. Services Provided by a Hospital or Other Facility, and Ambulance Services, 5(e). In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including (or any amounts you desire). The rates presented here are for BCBS FEP Dentals most populous region, Region 1. The mandate applies to men, as well as women. Refer to Table Attachment for a chart to assist with medical necessity determination for implant removal. New Supplemental International Travel Insurance In such circumstances the specialty drug 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. You will have no success getting breast implants surgery covered by any insurance plan. Tricare/Champus. 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. Self Only biweekly premiums will be $9.22 This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Good luck. This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. endstream
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To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Although cosmetic procedures are never covered by insurance, certain procedures related to your surgery may be Services, drugs, or supplies related to abortions, except when the life of the mother would be endangered if the fetus were carried to term, or when the pregnancy is the result of an act of rape or incest. WebAlthough we may list a specific service as a benefit, we will not cover it unless we determine it is medically necessary to prevent, diagnose, or treat your illness, disease, injury, or condition. and SM Service Marks are the property of their respective owners. Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined in consultation with the attending physician and the individual. ART-20203231. WASHINGTON, Sep. 30, 2021 Today the Blue Cross and Blue Shield (BCBS) Government-wide Service Benefit Plan, also known as the Federal Employee Membership or concierge service fees charged by a healthcare provider. ? 5(a). Includes codes L8020, L8030, L8031, L8032, and L8035. 1-800-472-2689 (TTY : 711) . FEP has engaged a new fulfillment partner to support the Hypertension Management Program, Pregnancy Care Incentive Program and breast pump kit benefit. c -8e)f`d ud`|Qh Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele1-800-472-2689 TTY: 711). Generally, you must exhibit physical, objective symptoms to qualify. <>/Metadata 1172 0 R/ViewerPreferences 1173 0 R>>
Leading the way in health insurance since 1929. I'm currently pear shaped. Self Only biweekly premiums will be $5.55 3You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. Services, drugs, or supplies you receive without charge while in active military service. Step 1: Cut off foot of panty hose and insert dry long grain rice and tie the ends. 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. Please see your subscriber certificate for details about your plan coverage. Under Basic Option, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care. My health insurance is an HMO plan. Furniture (other than medically necessary durable medical equipment) such as commercial beds, mattresses, chairs. Grade IV: Breast is hard, painful, cold, tender, and distorted. %PDF-1.5
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Quantity Level Limits For Breast Prosthetics. 2 0 obj
WebReview the links below for information relevant to your coverage. Additional information about 2022 benefits is available online or by calling the National Information Center. hb```,RQ 2023 Blue Cross Blue Shield Association. hWmo8+|lu Before making a final decision, please read the Plans federal brochure (RI 71-005). 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. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. If you need further surgery later on, your health insurance may not cover that, either. Limit your coverage. You will have no success getting breast implants surgery covered by any insurance plan. Most physicians will offer financing through an outside fin 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. Cancer does not have to be the reason for the mastectomy. 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! Hello.Thank you for your questions. Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware Roughly a third of Americans have healthcare insurance through a Blue Cross Blue Shield company. PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. There are lots of implant options out there. EUmsCd}]'`d w! M
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In those individuals who had originally undergone breast implantation for reconstructive purposes. Insurance usually will not cover breast enlargement surgery. stream
x( &wF@R\XYK00Ha,le+j p Nipple sparing/skin sparing mastectomy may be considered medically necessary when there is no cancer involving the skin, nipple or areola. Enhanced Dental and Vision Benefits for Children Incontinence products such as incontinence garments (including adult or infant diapers, briefs, and underwear), incontinence pads/liners, bed pads, or disposable washcloths. , 1-800-472-2689(: 711). For information on obtaining prior approval for specific services, such as transplants, see Section 3, You need prior Plan approval for certain services. %%EOF
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. Applied behavior analysis (ABA) services and related services performed as part of an educational program; or provided in or by a school/educational setting; or provided as a replacement for services that are the responsibility of the educational system. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. 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. Self and Family biweekly premiums will be $16.64, Standard Option: LU . Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware of. Sometimes, we can work with the HR department of larger companies (especially the ones with more progressive attitudes) to help make your surgery possible. This specialized team of clinical experts, mental health experts, and psychiatrists is available for comprehensive support. -4f$&mGI This is a fixed cost price with unlimited follow up. Self Only biweekly premiums will be $80.18 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. Complications of breast implants are common and may require removal of the implant. 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.
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