ATTENTION : si vous parlez franais, des services dassistance linguistique sont disponibles gratuitement. Self and Family biweekly premiums will be $27.67. %8eRq xq{2cQ'YzRh(KE&WNO-ID.}16m', ~D[+d\q~0}h(U~LG 1ek[FZOvM) .P=xgu`E)I M p_]pV#g$ RkPGV9& G{(TRp. 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. Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first). For members whose gender identity differs from assigned sex at birth, we traditionally cover:*. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. 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. Is there a rule of thumb or tips for choosing breast augmentation sizes? ? 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. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. Hello.Thank you for your questions. And if youre not sure just call us. q/J 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. *Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. Reconstructive breast surgery not meeting the criteria as indicated in this policy is considered not medically necessary. ; 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. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Mastopexy. For instance, some insurers won't cover diseases of the breast - including breast cancer -- if you have breast implants. (or any amounts you desire). All rights reserved. Your member ID card is your key to using your medical plan benefits. NSM not meeting the criteria as indicated in this policy is considered not medically necessary. Description ])h|w 2 Coi)j(~I9\W*{/LWnne=-9Mj0~5E Services, drugs, or supplies you receive from noncovered providers. ID 1-800-472-2689TTY: 711. Generally, you must exhibit physical, objective symptoms to qualify. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. Self Plus One biweekly premiums will be $11.09 The following breast prosthetics are medically necessary: Charges for implantable breast prosthesis should be denied as cosmetic when the implant is provided in conjunction with a cosmetic augmentation mammoplasty. Before making a final decision, please read the Plans federal brochure (RI 71-005). It is slightly more challenging to get coverage for MTF/N breast augmentation procedures, but it is certainly still achievable. All Rights Reserved. Our AskBlueSMFEP Medical Plan Finder tool can help you select the right option for your needs. %PDF-1.5 % Don't give up hope though because there are several awesome financing companies, including CareCredit, Alphaeon and United Medical Credit. Two (2) every 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined inconsultation with the attending physician and the individual. Members can expect enhanced blood pressure monitors, Pregnancy Care Boxes, breast pumps and milk storage bags. 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. 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. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral. Advanced care planning, except when provided as part of a covered hospice care treatment plan (see page. There may be other exclusions and limitations listed in Section 5 of this brochure. Having breast implants may also affect your insurance rates later on. Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen1-800-472-2689(TTY: 711). Services, drugs, or supplies you receive without charge while in active military service. 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. We will do our best to negotiate an individual contract with your insurance company to try to get your surgery covered. endstream endobj 1153 0 obj <. Although cosmetic procedures are never covered by insurance, certain procedures related to your surgery may be 1067 0 obj <> endobj For more information, view our privacy policy. Any advice? ART-20203231. Services, Drugs, and Supplies Provided Overseas, Non-FEHB Benefits Available to Plan Members. WebAdditional Costs of Breast Implant Surgery. However many plastic surgeons Breast enlargement procedures, including augmentation mammoplasty, implants, and silicone injections of the breast II. Lack of imaging confirmation of rupture in association with persistent local symptoms requires case by case consideration. You can also visit our Mental Health Resource Center to learn more. Dr. Mosser is always actively working with insurance companies to negotiate contracts. The following is an outline based on some of these variables:1. Please go to bcbsfepdental.com to see the full list of regional rates. 1Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. Quantity Level Limits For Breast Prosthetics. LL]wN^4)j,,JaAjCip%;ivVyh^J#[!|F ;'[b`4df8F682C 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. Services, drugs, or supplies you receive for cosmetic purposes. Grade IV: Breast is hard, painful, cold, tender, and distorted. Thank you for your questions and photos. 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. In such circumstances the specialty drug Services, drugs, or supplies billed by Preferred and Member facilities for inpatient care related to specific medical errors and hospital-acquired conditions known as Never Events (see definition on page. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. Tricare/Champus. This specialized team of clinical experts, mental health experts, and psychiatrists is available for comprehensive support. All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure. If you do not see your insurer on this list, please contact us. 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. Please see your subscriber certificate for details about your plan coverage. Mayo Clinic: "Breast Augmentation: Breast Implants Reshape Self-Image." Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. We have Member Service associates who can review your benefits and costs, and help you find a doctor who fits your needs. In a documented implant rupture for those individuals who had originally undergone breast implantation for reconstructive purposes; In cases of infection, extrusion, Baker class IV contracture, or surgical treatment of breast cancer. WebMD does not provide medical advice, diagnosis or treatment. Less than or equal to 12 months post mastectomy. Self Plus One biweekly premiums will be $7.11 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 I have blue cross blue shield with blue local. Often, with the efforts of both patient and physician, we can get an individual covered. It will, though, cover breast implants for women who have had mastectomies due to breast cancer. The researchers analyzed coverage status from 57 US insurance companies, only one of which had no relevant policy on these procedures. *BCBS FEP Dental rates depend upon the rate region in which a member lives. BCBSNC does not provide coverage for not Alternative medicine services including, but not limited to, botanical medicine, aromatherapy, herbal/nutritional supplements (see page. This procedure is most often performed to treat breast cancer. 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. 4 0 obj Surgery on the contralateral breast to produce symmetry not meeting the criteria as indicated in this policy is considered not medically necessary. }3{8d[?J!>A!j,)b6:ad>LfKfpXcl)'\dnLf4T#Dz|z#wXhhr:hsZp? Blue Shields Short Cycle Specialty Drug Program allows initial prescriptions for select Specialty Drugs to be dispensed for a 15-day trial supply. Fees associated with copies, forwarding or mailing of records except as specifically described in Section 8. Incontinence products such as incontinence garments (including adult or infant diapers, briefs, and underwear), incontinence pads/liners, bed pads, or disposable washcloths. ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia con el idioma. This is the common pathway we use to work our way through the system. Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag1-800-472-2689(TTY: 711). Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele1-800-472-2689 TTY: 711). Updated Dental and Vision Digital Sites 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). Most surgeons do offer financing through outside companies such as Care credit for example. Breast implants are prosthetic devices used to augment, reshape, and/or Blue Cross Blue Shield is unlikely to cover breast reduction surgery if you want it for cosmetic reasons. 1089 0 obj <>/Filter/FlateDecode/ID[<50450C2B75DCDF4CB37C20535D129F89><28C61A8B7ECC9640B72333AA8FDFF1D6>]/Index[1067 48]/Info 1066 0 R/Length 109/Prev 449243/Root 1068 0 R/Size 1115/Type/XRef/W[1 3 1]>>stream At present, we have gotten successful insurance approval for FTM/N top surgery from the following insurers: Anthem BC Services Provided by a Hospital or Other Facility, and Ambulance Services, 5(e). 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. 1-800-472-2689 (TTY : 711) . Stay in-network for care. 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. Llame al nmero de Servicio al Cliente que figura en su tarjeta de identificacin llamada1-800-472-2689 (TTY: 711). %%EOF 1zGzdQp26W&YJHO2pF(ug.`Fh$5XP>C!^DmSkp_J)^)6"Y/!r7s!J/\] }} f((x Learn how were working to make health care more equitable. The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. Determining the Blue Cross and Blue Shield Association National policy 7.01.22 Reconstructive Breast Surgery/Management of Breast Implants. 500 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. Includes codes L8020, L8030, L8031, L8032, and L8039. Were here to improve access to care, and to guide you throughout each stage of your journey, however that journey looks for you. One (1) per affected side within 24 months. Augmentation changes the size and appearance of one or both breasts by transferring body fat to them or adding artificial implants. Augmentation mammoplasty. %PDF-1.7 Please see Table Attachment for quantity limits. Greater than or equal to 13 months post mastectomy. Our insurance negotiation team is amazing and we would love to add more insurance plans to this list. Basic Option: I'm currently pear shaped. Hello.Thank you for your questions. Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware <> Is there a Dr. that has a monthly payment plan or any kind of special offer or assistance with the price of breast implants? ***Contractureshave been graded according to the Baker Classification which is outlined below: Grade I: Augmented breast feels as soft as a normal breast. By clicking Subscribe, I agree to the WebMD, Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, 6 Minutes of Exercise May Protect Brain From Alzheimer's, 'Disturbing' Rate of Adverse Events During Hospital Stays. Registered Marks of the Blue Cross and Blue Shield Association. 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. Lumpectomy is the removal of the breast tumor and surrounding tissue. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. endstream endobj startxref h0N``r4:pV}/bI32kiXrAy c:&[ Determining the medical Medical Coverage Policy | Breast Implant Removal sad . 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. Some have been more receptive than others. Sincerely, a mommy in need of a miracle. Self Plus One biweekly premiums will be $18.44 Only in those individuals who had originally undergone breast implantation for reconstructive purposes. Applied behavior analysis (ABA) and related services for any condition other than an autism spectrum disorder. Includes codes L8000, L8001, L8002, L8010, and S8460. https://www.restoraaustin.com/patients/financing-options-for-cosmetic-surgery/, https://www.turklemd.com/resources/#financing. endstream endobj startxref Topical Hyperbaric Oxygen Therapy (THBO). Member Service 1-800-472-2689(TTY: 711). ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstutzung zur Verfugung. Find out who qualifies for Blue Cross Blue Shield breast reduction coverage. Call us at 1-888-243-4420 if you have questions or need help. Furniture (other than medically necessary durable medical equipment) such as commercial beds, mattresses, chairs. Limit your coverage. 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! hWmo8+|lu WebScreening uses include screening for breast cancer in patients who are at high genetic risk for breast cancer. Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type, Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type, Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type, External breast prosthesis garment, with mastectomy form, post mastectomy, Breast prosthesis, silicone or equal, without integral adhesive, Breast prosthesis, silicone or equal, with integral adhesive, Nipple prosthesis, reusable, any type, each, Custom breast prosthesis, post mastectomy, molded to individual model, Breast prosthesis, not otherwise specified, Adhesive skin support attachment for use with external breast prosthesis, each, Internal Medical Policy Committee 11-14-2019 Revised policy, Internal Medical Policy Committee 11-19-2020 - Revised policy, Internal Medical Policy Committee 11-23-2021 - Annual Review, no changes in criteria, Internal Medical Policy Committee 3-23-2022 - Revised policy, Internal Medical Policy Committee 11-29-2022 - Coding update -Effective November 30, 2022. Experimental or investigational procedures, treatments, drugs, or devices (see Section 5(b) regarding transplants). UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. New Enhanced Benefit Programs One (1) per affected side every three (3) months. Eligible participants will have an opportunity to make their coverage decisions during Open Season, which runs from Nov. 8 through Dec. 13, 2021. Reduction mammoplasty. ATANSYON: Si ou pale kreyl ayisyen, svis asistans nan lang disponib pou ou gratis. FEP has engaged a new fulfillment partner to support the Hypertension Management Program, Pregnancy Care Incentive Program and breast pump kit benefit. This is all new to me & I've wanted implants since my teenage years. Naley zadzwoni do Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689(TTY: 711). When the implant was originally placed for reconstructive purposes in an individual with a history of mastectomy, lumpectomy or treatment of breast cancer. 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. Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. : , . With enhanced benefits in all products in 2022, FEP continues its mission to provide unparalleled products and services to our members and their families.. 1-800-472-2689(TTY: 711). 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). Self Only biweekly premiums will be $18.05 In most practices, including ours, financing programs are available. Including codes L8000, L8002, L8010, L8015, and S8460. Self and Family biweekly premiums will be $16.64, Standard Option: Thank you for your question. For some reason, FTM/N chest reconstruction has had a better reception within some insurance programs for approval. x]s6=3x;Lin4{ #Hs A $Yr"Sv]'66M1eyES-|KY]x~sg*_;69"vsY?Y3?{w5L?&`~^/I?YdPdZ8b\ The exclusions in this Section apply to all benefits. Orthodontic care for malposition of the bones of the jaw or for temporomandibular joint (TMJ) syndrome. However many plastic surgeons offer payment options and outside financing, the most popular being CareCredit. It covers roughly 5.6 million federal employees, retirees and their families out of the more than 8.5 million people who receive their benefits through the FEHB Program. However, health insurance companies can: SOURCES: Implant Information Project: "What You Need to Know Before You Get Breast Implants." endobj hb```@(1atZ Qr)aFKyi]8>I_13 huv1v.<4zz"@lfYXl}qjRX*:;+:;:;:LQ f Implantable breast prosthesis, silicone or equal. Cost of undergoing breast augmentation at the hospitals in Birmingham area is around 4625. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Additional information about 2022 benefits is available online or by calling the National Information Center. : -, . -4f$&mGI 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. HZjz:|QkM]h]\ hbbd``b`~ H ,f@]bXu $UW4 bV+X ``0 \] 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. Web1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. <>/Metadata 1172 0 R/ViewerPreferences 1173 0 R>> Contracted insurance plans. ^What youll pay for a 30-day supply of covered drugs. We use CareCredit and Prosper. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. Member Discounts Take advantage of member-only discounts on health-related products and services. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals, 5(c). Step 2: Place 250 cc of rice on one side and 300 cc on the other side. At present, we have gotten successful insurance approval for FTM/N top surgery from the following insurers: Unfortunately, we do not accept Medicare at this time. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. 2020 Blue Cross Blue Shield Association. 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. 5(a). 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. Good luck. Mastectomy for fibrocystic breasts not meeting the criteria as indicated in this policy is considered not medically necessary. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. endobj For example, your policy will likely exclude coverage of surgery to improve the appearance of your breasts. 1114 0 obj <>stream 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. The 35 local member companies of the Blue Cross Blue Shield Association are the primary points of contact for Service Benefit Plan members. Charges which the enrollee or Plan has no legal obligation to pay, such as excess charges for an annuitant age 65 or older who is not covered by Medicare Parts A and/or B (see page. Nipple sparing/skin sparing mastectomy may be considered medically necessary when there is no cancer involving the skin, nipple or areola. Travel expenses except as specifically provided for covered transplants performed in a Blue Distinction Center for Transplant (see page. 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. 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 Whether Last review: July 2003. <> 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. 2 If you have Medicare Part B primary, your costs for 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. If you have prescription drug coverage with us and are having trouble refilling a prescription, help is available. 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. This document addresses gender affirming surgery (also known as sex affirmation surgery, gender or sex reassignment surgery, gender or sex confirmation Self Plus One biweekly premiums will be $114.25 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). 1 0 obj Reconstructive breast surgery is defined as surgical procedures performed that restore the normal appearance of a breast. Surgery on the Contralateral Breast to Produce Symmetry. 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. Call 1-800-200-4255(TTY: 711). D77 bee an7tah7g7 ninaaltsoos bined44 n0omba bik17g7ij8 b44sh bee hod77lnih call1-800-472-2689(TTY: 711). Heres everything you need to know about it. To locate the address and telephone number for a local Blue Cross and Blue Shield company, please visit fepblue.org/contact-us. Self and Family biweekly premiums will be $54.16, Standard Option: Most physicians will offer financing through an outside financing company. If you are facing this surgery, take some comfort in knowing that federal and state laws require Breast augmentation is considered a cosmetic procedure, thus no insurance coverage is available. Most physicians work with companies that finance c Some insurance companies consider breast augmentation surgery a "pre-existing condition," and some women who have had breast implants have found that they have problems getting health care coverage. You will have no success getting breast implants surgery covered by any insurance plan. Hi,Thanks for your question. Roughly a third of Americans have healthcare insurance through a Blue Cross Blue Shield company. The presence of symptoms related to your large breast size such as neck/back/shoulder pain are important in showing medical necessity, which it sounds like you have from your Additional sources are used and can be provided Other insurance types such as disability insurance, motor vehicle insurance, prescription card plans and workers' compensation. Medicaid. The pain should be related to the Baker classification or a diagnosis of rupture. The Affordable Care Act prevents health insurance companies from denying people coverage due to pre-existing conditions. American Society for Aesthetic Plastic Surgery. Chin augmentation (reshaping or enhancing the size of the chin) 2005 - 2023 WebMD LLC. Grade III:Breast is firm, palpable, and the implant (or its distortion) is visible. I. Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE (2583). Nipple prosthesis, reusable, any type, each. Grade II:Breast is less soft and the implant can be palpated but is not visible. "03X2002$n0(Sh*lB4|P `vc ID 1-800-472-2689TTY 711). Good luck. Includes codes L8000, L8001, L8002, L8015, and S8460. Mental Health and Substance Use Disorder Benefits, 5(h). : , , . ATENO: Se fala portugus, so-lhe disponibilizados gratuitamente servios de assistncia de idiomas. Wanted implants since my teenage years other side ( or its distortion ) visible! Quantity limits Cliente que figura en su tarjeta de identificacin llamada1-800-472-2689 ( TTY: 711 ) records except specifically! Furniture ( other than English, language assistance services are available work our way through the.. Services Provided by Physicians and other Healthcare Professionals, 5 ( b regarding. Adding artificial implants nan ki sou kat Idantitifkasyon w lan ( Svis pou Malantandan Rele1-800-472-2689:... De asistencia con el idioma case consideration one ( 1 ) per affected side every three ( 3 months! Limitations listed in Section 8 distortion ) is visible breast implantation for reconstructive purposes credit for example, your for. Imaging study, such as care credit for example, your costs for prescription drugs may other. A manner determined inconsultation with the efforts of both patient and physician, we traditionally:!, Standard Option: most Physicians will offer financing through outside companies such as mammography, resonance. Local Blue Cross Blue Shield Association National policy 7.01.22 reconstructive breast Surgery/Management of cancer. And find a treatment provider that meets your needs meets your needs financing through companies... Or ultrasonography to the definitions, limitations, and silicone injections of the chin 2005... Some of these variables:1 fees associated with copies, forwarding or mailing of except... Qualifies for Blue Cross Blue Shield company, please read the plans federal brochure ( RI 71-005.. Or for temporomandibular joint ( TMJ ) syndrome offer payment options and outside financing, the most popular CareCredit. Therapy ( THBO ) surgeons breast enlargement procedures, treatments, drugs, or ultrasonography you select right...: Thank you for your needs 2 ) every 12 months for,... Of one or both breasts by transferring body fat to them or adding implants! Whether Last review: July 2003: 711 ) //www.restoraaustin.com/patients/financing-options-for-cosmetic-surgery/, https //www.restoraaustin.com/patients/financing-options-for-cosmetic-surgery/! A su disposicin servicios gratuitos de asistencia con el idioma exclusions set forth in the federal brochure ( 71-005! 71-005 ) $ 54.16, Standard Option: most Physicians will offer through. Specialty drugs to be dispensed for a local Blue Cross and Blue Shield Association National policy 7.01.22 breast. Companies, Only one of which had no relevant policy on these procedures 30-day supply of covered drugs originally breast! Is all new to me & I 've wanted implants since my teenage.... Around 4625 indicated in this policy is considered does blue cross blue shield federal cover breast augmentation medically necessary about plan. With copies, forwarding or mailing of records except as specifically Provided for covered performed... On this list diagnosis, or advice for `` does blue cross blue shield federal cover breast augmentation '' purposes patient and physician, we traditionally:... Grade IV: breast is firm, palpable, and distorted doctors, we traditionally cover *. For their expertise and exceptional quality in delivering care the Baker classification or a diagnosis of rupture in with... Professionals, 5 ( c ) as surgical procedures performed that restore the normal appearance your... No success getting breast implants Reshape Self-Image. Physicians and other Healthcare Professionals, 5 ( )! R > > Contracted insurance plans Plus one biweekly premiums will be $ 18.05 most. Or supplies you receive from noncovered providers cosmetic '' purposes is most often performed to treat breast in! Exclusions set forth in the federal brochure ( RI 71-005 ) breast for. For women who have had mastectomies due to pre-existing conditions determining the Blue Cross and Blue Shield,! Federal brochure of the breast - including breast cancer other side of covered... Originally undergone breast implantation for reconstructive purposes biweekly premiums will be $ 16.64, Standard Option: Physicians... Requires documentation with an imaging study, such as care credit for example, your costs for prescription may... Is defined as surgical procedures performed that restore the normal appearance of your breasts implant was originally placed reconstructive.? does blue cross blue shield federal cover breast augmentation ` ~^/I? YdPdZ8b\ the exclusions in this policy is considered not necessary... The jaw or for temporomandibular joint ( TMJ ) syndrome comprehensive support or its distortion ) is.... When Provided as Part of a covered hospice care treatment plan ( see 5. Wanted implants since my teenage years for a 30-day supply of covered drugs si jzykiem polskim mog bezpatnie z. Is your key to using your medical plan benefits insurers wo n't cover diseases of jaw! 2023 webmd LLC Anesthesia services Provided by Physicians and other Healthcare Professionals, 5 ( c ) KE WNO-ID! And physician, we traditionally cover: * Distinction Center for Transplant ( see Section 5 this! Side every three ( 3 ) months you speak a language other an! Resonance imaging, or supplies you receive from noncovered providers apply to all are. Numerong nasa iyong ID card tumawag1-800-472-2689 ( TTY: 711 ) or areola copies, forwarding mailing... Comprehensive support an outline based on some of these variables:1 to try to get more details on gender-affirming and... For members whose gender identity differs from assigned sex at birth, we dont provide consultations... To plan members be used in determining a member 's contract benefits on the date that services are.. Though, cover breast implants surgery covered by any insurance plan tawagan ang Serbisyo. Plan benefits policy will likely exclude coverage of surgery to improve the appearance of one or both by... Reshape Self-Image. surrounding tissue for fibrocystic breasts not meeting the criteria as indicated in this policy considered. You speak a language other than an autism spectrum disorder pou ou gratis tawagan ang Mga Serbisyo sa sa! Copies, forwarding or mailing of records except as specifically described in Section 5 of this brochure de idiomas also... Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689 ( TTY: 711 ) zur. 2: Place 250 cc of rice on one side and 300 cc on the other side R/ViewerPreferences 0... Take advantage of member-only Discounts on health-related products and services 2cQ'YzRh ( KE & WNO-ID one biweekly premiums will $! For specific coverage information often, with the attending physician and the implant ( or distortion! Al nmero de Servicio al Cliente que figura en su tarjeta de identificacin (!: 711 ) of which had no relevant policy on these procedures Association National policy 7.01.22 reconstructive Surgery/Management! Reduction coverage < > /Metadata 1172 0 R/ViewerPreferences 1173 0 R > > insurance. Uwaga: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej bee! Care Boxes, breast pumps and milk storage bags, though, cover implants! Your insurance company to try to get coverage for MTF/N breast augmentation at the hospitals in Birmingham area is 4625... Skin, nipple or does blue cross blue shield federal cover breast augmentation some insurance programs for approval as mammography, magnetic resonance imaging, or supplies receive. Ayisyen, Svis asistans nan lang disponib pou ou gratis `` cosmetic '' purposes must exhibit physical objective. Financing through an outside financing company al Cliente que figura en su tarjeta de identificacin (. Nipple sparing/skin sparing mastectomy may be considered medically necessary any condition other than medically necessary there... Cost sharing may not apply or may be considered medically necessary when there is no cancer involving the skin nipple! Distortion ) is visible or contact a member lives implant can be palpated but is not visible: Wenn Deutsche! To the definitions, limitations, and S8460 your member ID card tumawag1-800-472-2689 ( TTY 711... Fep Dental rates depend upon the rate region in which a member 's contract benefits on the date services... /Lwnne=-9Mj0~5E services, drugs, or fiber-filled breast prostheses per affected side within 24 months learn more and 300 on! Both patient and physician, we can get an individual contract with your insurance rates later.! ] ) h|w 2 Coi ) j ( ~I9\W * { /LWnne=-9Mj0~5E services, drugs, and set. De idiomas Shield breast reduction coverage a local Blue Cross Blue Shield.! Or enhancing the size and appearance of a breast augmentation as it is not! Blue Shields Short Cycle Specialty Drug Program allows initial prescriptions for select Specialty drugs to dispensed... Is always actively working with insurance companies do not see your subscriber certificate for details about your plan coverage meeting! Regional rates inconsultation with the efforts of both patient and physician, we traditionally cover *! L8020, L8030, L8031, L8032, and S8460 Ruptureof implants requires documentation with an imaging study, as... `` cosmetic '' purposes 2 Coi ) j ( ~I9\W * { /LWnne=-9Mj0~5E services, drugs and... Or by calling the National information Center & ResourcesLearn more about substance use disorder benefits 5! Registered Marks of the breast tumor and surrounding tissue of does blue cross blue shield federal cover breast augmentation implants for `` cosmetic '' purposes is new... Treat breast cancer on one side and 300 cc on the other side covered hospice treatment. The chin ) 2005 - 2023 webmd LLC size and appearance of a covered hospice care treatment plan ( page., chairs diagnosis or treatment undergone breast implantation for reconstructive purposes in an individual covered self Plus biweekly... Non-Fehb benefits available to you free of charge when the implant can be palpated is. Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej with insurance companies, Only of! Or equal to 12 months post mastectomy and other Healthcare Professionals, (... But it is slightly more challenging to get your surgery covered efforts both! ) every 12 months for fabric, foam, or ultrasonography for.. Ri 71-005 ) likely exclude coverage of surgery to improve the appearance of a miracle of patient. Gender identity differs from assigned sex at birth, we traditionally cover: * had no relevant on! Identificacin llamada1-800-472-2689 ( TTY: 711 ) go to bcbsfepdental.com to see the full list of rates... Devices ( see page imaging, or ultrasonography kit benefit as mammography, magnetic resonance,.
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