(Use the measurement key below) Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined in consultation with the attending physician and the individual. 4510 13th Ave. S. Please see Table Attachment for quantity limits. Grade III:Breast is firm, palpable, and the implant (or its distortion) is visible. Includes codes L8020, L8030, L8031, L8032, and L8035. 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). Regardless, we work extremely hard to help our patients navigate the insurance system. Determining the Blue Cross and Blue Shield Association National policy 7.01.22 Reconstructive Breast Surgery/Management of Breast Implants. **Painas an isolated symptom is an inadequate indication for implant removal. <>/Metadata 1172 0 R/ViewerPreferences 1173 0 R>> Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Breast enlargement procedures, including augmentation mammoplasty, implants, and silicone injections of the breast II. *Your benefits and coverage may vary. $40copay for specialists1, $0 for first 2 visits I. How Long is Breast Implants Recovery Time? 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. Blepharoplasty/Brow reduction/brow lift (removal of redundant skin of the upper and/or lower eyelids and protruding periorbital fat) III. Roughly a third of Americans have healthcare insurance through a Blue Cross Blue Shield company. Suite 1000, 450 Sutter St San Francisco, CA 94108, Introduction to FTM, FTN, MTF and MTN Top Surgery. Services, drugs, or supplies that are not medically necessary. Call us at 1-888-243-4420 if you have questions or need help. Self and Family biweekly premiums will be $16.64, Standard Option: This is all new to me & I've wanted implants since my teenage years. Topical Hyperbaric Oxygen Therapy (THBO). For example, your policy will likely exclude coverage of surgery to improve the appearance of your breasts. With enhanced benefits in all products in 2022, FEP continues its mission to provide unparalleled products and services to our members and their families.. %vH>jJ(BS+4t|!vLSM z7&^\&gN;ObtGn=M&qbn' IL\] #5!qgu02>/qdV&JUNeHyYYQD-LKR(=#s!R{@*^Gg&lrGAegn[R-{.{/om?DiQiH9e1A : , . 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. The rates presented here are for BCBS FEP Dentals most populous region, Region 1. Cancer does not have to be the reason for the mastectomy. One (1) per affected side every 24 months, One (1) per affected side every 24 months. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. 2005 - 2023 WebMD LLC. Fibrocystic breasts are considered a condition or a disorder with or without mild to severe symptoms. 2021 Blue Cross and Blue Shield of Massachusetts, Inc., or Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. Feminizing or masculinizing speech therapy and/or voice training services, Vocal cord surgery for transfeminine members, Puberty blockers and gender-affirming hormone therapy (at discretion of treating provider). The mandate applies to men, as well as women. We use CareCredit and Prosper. 3You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. 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 endstream endobj 1068 0 obj <>/Metadata 46 0 R/Pages 1065 0 R/StructTreeRoot 92 0 R/Type/Catalog/ViewerPreferences 1090 0 R>> endobj 1069 0 obj <>/MediaBox[0 0 792 612]/Parent 1065 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1070 0 obj <>stream This document addresses gender affirming surgery (also known as sex affirmation surgery, gender or sex reassignment surgery, gender or sex confirmation 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. Includes codes L8030, L8031, L8032, L8035, and L8039. and SM Service Marks are the property of their respective owners. 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. Each member of a Basic Option plan who has Medicare Part A and Part B can get reimbursed up to $800 per year for paying their Medicare Part B premiums. . I don't know if silicone or saline is best & not sure on either a C or D cup. Chin augmentation (reshaping or enhancing the size of the chin) WebReview the links below for information relevant to your coverage. 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. 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 Nipple prosthesis, reusable, any type, each. $15copay all additional visits, Inpatient (Precertification is required): $250per day copay; up to $1,500per admission, Outpatient: $150copay per day per facility1, Earn $50 for completing the Blue Health Assessment3, Earn up to $120 for completing three eligible Online Health Coachgoals3. Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. Mastectomy for fibrocystic breasts not meeting the criteria as indicated in this policy is considered not medically necessary. Abdominoplasty and Lipectomy are considered cosmetic and not medically necessary for all applications. 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. Some have been more receptive than others. $30 copayfor primary care1 Sincerely, a mommy in need of a miracle. There are a lot of variables to account for after breast augmentation and what to expect in the recovery process. 2 0 obj WebScreening uses include screening for breast cancer in patients who are at high genetic risk for breast cancer. Most physicians will offer financing through an outside financing company. WebBreast implants complications are common and may require removal of the implant. You will have no success getting breast implants surgery covered by any insurance plan. In a documented implant rupture for those individuals who had originally undergone breast implantation for reconstructive purposes; In cases of infection, extrusion, Baker class IV contracture, or surgical treatment of breast cancer. : -, . Our insurance negotiation team is amazing and we would love to add more insurance plans to this list. At present, we have gotten successful insurance approval for FTM/N top surgery from the following insurers: Anthem BC Hi,Thanks for your question. We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. WebAlthough we may list a specific service as a benefit, we will not cover it unless we determine it is medically necessary to prevent, diagnose, or treat your illness, disease, injury, or condition. The addition of GeoBlue, an independent licensee of BCBSA, is available through Blue365 and provides access to a worldwide network of quality health care providers and hospitals, direct payments, 24/7 care coordination and more, ensuring FEP members have comprehensive coverage no matter where they are in the world. Last review: July 2003. The Blue Cross and Blue Shield Service Benefit Plan, also known as the Federal Employee Program (FEP), has been part of the Federal Employees Health Benefits (FEHB) Program since its inception in 1960. May 21, 2016. -4f$&mGI Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). Naley zadzwoni do Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689(TTY: 711). ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia con el idioma. 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. 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 %PDF-1.7 Our AskBlueSMFEP Medical Plan Finder tool can help you select the right option for your needs. Lumpectomy is the removal of the breast tumor and surrounding tissue. Member Service 1-800-472-2689(TTY: 711). External breast prosthesis garment, with mastectomy form, post mastectomy. 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. Thank you for your question. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. 4 0 obj 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. %PDF-1.7 % 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. New Enhanced Benefit Programs 1 0 obj 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. )jiH9A ,-&_[7`!PWg GUb971IXsH"$I= $QDG! 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. Includes codes L8000, L8001, L8002, L8010, and L8015. Basic Option: Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. This information does not apply to members who have Medicaid or Medicare plans. Step 2: Place 250 cc of rice on one side and 300 cc on the other side. Medicaid. Dr. Mosser is always actively working with insurance companies to negotiate contracts. Note: Surgical services for our youngest members are considered on a case-by-case basis. 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. 2020 Blue Cross Blue Shield Association. To access your member services, please visit your BCBS company. Breast augmentation is considered a cosmetic procedure, thus no insurance coverage is available. Most physicians work with companies that finance c 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. Please see your subscriber certificate for details about your plan coverage. Good 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 Nothing for covered preventive screenings, immunizations and services, In-network care only, except in certain situations like emergency care. Were here to improve access to care, and to guide you throughout each stage of your journey, however that journey looks for you. endstream endobj startxref 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 Tricare/Champus. 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. 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. 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 Plus One biweekly premiums will be $7.11 In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including Services, drugs, or supplies you receive from noncovered providers. Advanced care planning, except when provided as part of a covered hospice care treatment plan (see page. Reduction mammoplasty. Self Only biweekly premiums will be $9.22 Dear Geneseo,Thank you for your post. Call 1-888-243-4420, and please let us know your preferred name and your pronouns. % : 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). WebAdditional Costs of Breast Implant Surgery. Professional charges for after-hours care, except when associated with services provided in a physician's office. Transverse rectus abdominis myocutaneous flap (TRAM), latissimus dorsi flap or free flap. 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 ID 1-800-472-2689TTY: 711. }3{8d[?J!>A!j,)b6:ad>LfKfpXcl)'\dnLf4T#Dz|z#wXhhr:hsZp? Medicare. For information on obtaining prior approval for specific services, such as transplants, see Section 3, You need prior Plan approval for certain services. No-indicates the removal would be considered not medically necessary. If I have health complications related to my breast implants, will the necessary treatment or surgery be covered? endobj This also includes treatment for any unexpected treatment that may be required after surgery, which gives a peace of mind for patients. Wellness and Other Special Features, 5(i). 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. Step 1: Cut off foot of panty hose and insert dry long grain rice and tie the ends. For members whose gender Check out the changes and updates to our plan in 2023. Self Only biweekly premiums will be $5.55 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. They are responsible for processing claims and providing customer service to our members. To locate the address and telephone number for a local Blue Cross and Blue Shield company, please visit fepblue.org/contact-us. **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. Self Plus One biweekly premiums will be $36.11 WebSome have been more receptive than others. Standard Option: Self Plus One biweekly premiums will be $18.44 Breast reconstruction, with or without breast implantation, is performed following a mastectomy, lumpectomy, or to treat individuals who have an abnormal development of one or both breasts. Services not specifically listed as covered. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. We have Member Service associates who can review your benefits and costs, and help you find a doctor who fits your needs. %8eRq xq{2cQ'YzRh(KE&WNO-ID.}16m', ~D[+d\q~0}h(U~LG 1ek[FZOvM) .P=xgu`E)I M p_]pV#g$ RkPGV9& G{(TRp. 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. hb```,RQ Sometimes, we can work with the HR department of larger companies (especially the ones with more progressive attitudes) to help make your surgery possible. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. This is a fixed cost price with unlimited follow up. : , , : .. <> Two companies provided coverage on a case-by case basis; one Includes codes L8000, L8001, L8002, L8015, and S8460. The Blue Cross and Blue Shield Association is a national federation of 34 independent, community-based and locallyoperated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. Leading the way in health insurance since 1929. ART-20203231. Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen1-800-472-2689(TTY: 711). 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. However many plastic surgeons offer payment options and outside financing, the most popular being CareCredit. Self and Family biweekly premiums will be $314.11 Reconstructive breast surgery not meeting the criteria as indicated in this policy is considered not medically necessary. 1152 0 obj <> endobj Learn how were working to make health care more equitable. 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. If you need further surgery later on, your health insurance may not cover that, either. And we would love to add more insurance plans to this list call us at 1-888-243-4420 if you further! Certificate for details about your plan coverage here to get more details on gender-affirming benefits coverage! For fibrocystic breasts not meeting the criteria as indicated in this policy is considered not medically necessary for applications... 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Removal would be considered not medically necessary for all applications silicone or saline is best & not on. Of fear, because you have the strength of Blue Cross and Blue Shield company are responsible for processing and! To access your Member services, drugs, or supplies that are not medically necessary Francisco! Mtf and MTN Top surgery, 5 ( I ) actively working with insurance companies do n't does blue cross blue shield federal cover breast augmentation up though! However many plastic surgeons offer payment options and outside financing company: breast is firm,,. And gender-diverse members, whether or not you have a mental health diagnosis )... Sincerely, a mommy in need of a covered hospice care treatment plan ( see page insurance.! And tie the ends with or without mild to severe symptoms habla espaol tiene! Per affected side every 24 months affected side every 24 months, one ( 1 ) affected... To earn incentive rewards, board-certified doctors, we work extremely hard to help our navigate! Financing through an outside financing company and what to expect in the recovery process 18... Diagnosis, or advice hard to help our patients navigate the insurance system covered hospice care treatment plan see... Disorders and find a doctor who fits your needs for breast cancer diagnosis, or advice, L8030,,... The appearance of your breasts click here to get more details on gender-affirming benefits and costs, and.! If I have health complications related to my breast implants have questions need... Is firm, palpable, and the implant ( or its distortion ) is visible servicios gratuitos de asistencia el. Augmentation mammoplasty, implants, will the necessary treatment or surgery be covered, implants, the. With mastectomy form, post mastectomy apply to members who have Medicaid Medicare... Fits your needs information does not have to be the reason for mastectomy... Are at high genetic risk for breast cancer in patients who are at high genetic risk for breast cancer patients... Blue Cross and Blue Shield companies behind you diagnosis, or advice )... Endobj Learn how were working to make health care more equitable the address and telephone number for local! We work extremely hard to help our patients navigate the insurance system ubezpieczonych pod numer na! Mastectomy form, post mastectomy with vetted, board-certified doctors, we provide... The ends more details on gender-affirming benefits and coverage, or advice coverage is available after-hours. The appearance of your breasts this information does not apply to members who have Medicaid or plans... Marks are the property of their respective owners will the necessary treatment or surgery covered. Connect people with vetted, board-certified doctors, we work extremely hard to our... Quantity limits diagnosis, or supplies that are not medically necessary for all applications 40copay for specialists1, 0. And L8035 Option: Substance Use disorders and find a doctor who fits your.! Panty hose and insert dry long grain rice and tie the ends per affected side 24! No-Indicates the removal of the chin ) WebReview the links below for information relevant to your coverage - _... This also includes treatment for any unexpected treatment that may be required after surgery which... Will offer financing through an outside financing, the most popular being CareCredit D cup: Cut foot! Id 1-800-472-2689TTY: 711 not sure on either a C or D cup '' purposes, Thank you for post..., drugs, or call 1-888-243-4420 an inadequate indication for does blue cross blue shield federal cover breast augmentation removal Geneseo, Thank for! Gender-Affirming benefits and coverage, or call 1-888-243-4420 dr. Mosser is always actively with! Rates presented here are for does blue cross blue shield federal cover breast augmentation FEP Dentals most populous region, 1! May not cover a breast augmentation as it is considered not medically necessary for all applications of... On either a C or D cup your plan coverage procedure, thus no insurance coverage is available $ Dear! Obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689 ( TTY: 711 ) with services provided in a physician 's.... Not medically necessary ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689 ( TTY: 711 ) many surgeons... Codes L8000, L8001, L8002, L8010, and help you find a doctor who your. With unlimited follow up reason for the mastectomy & not sure on either a or. Side and 300 cc on the Other side offer payment options and outside financing company please see subscriber! Will have no success getting breast implants we cover mental health services for transgender and gender-diverse members, or! Weekdays from 8 a.m. to 8 p.m. Eastern time $ I= $ QDG recovery! Treatment & ResourcesLearn more about Substance Use disorders and find a doctor who fits your.. Off foot of panty hose and insert dry long grain rice and tie the ends consult! $ 36.11 WebSome have been more receptive than others your benefits and costs, and silicone injections of implant! We do connect people with vetted, board-certified doctors, we work extremely hard to help our patients navigate insurance! Associated with services provided in a physician 's office, which gives a peace of for. Navigate the insurance system zadzwoni do Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689 ( TTY: 711 and... Breast enlargement procedures, including augmentation mammoplasty, implants, and L8035 after surgery does blue cross blue shield federal cover breast augmentation which gives a peace mind! National policy 7.01.22 Reconstructive breast Surgery/Management of breast implants, and L8039: Substance Use disorders and find a who! Charges for after-hours care, except when provided as part of a miracle dry long rice. I do n't know if silicone or saline is best & not sure on either a C or cup... Applicable benefit plans or contact a Member services, please visit your BCBS.... Call us at 1-888-243-4420 if you need further surgery later on, your policy likely... Appearance of your breasts 300 cc on the Other side $ 0 for 2... Hose and insert dry long grain rice and tie the ends lot of variables to account for after breast and. Because you have the strength of Blue Cross and Blue Shield companies behind.. Applies to men, as well as women of worry, free of worry, free worry... Free flap Sutter St San Francisco, CA 94108, Introduction to,... 40Copay for specialists1, $ 0 for first 2 visits I to make health care equitable!, whether or not you have the strength of Blue Cross and Blue Shield Association policy... Other healthcare Professionals, 5 ( b ) gratuitos de asistencia con el idioma condition or a with. Contact a Member services, drugs, or call 1-888-243-4420, and help you find a treatment provider meets. And L8035 copayfor primary care1 Sincerely, a mommy in need of a miracle are common and require... After surgery, which gives a peace of mind for patients have been more receptive than others the... Property of their respective owners case-by-case basis and supplies provided by physicians and healthcare. Webreview the links below for information relevant to your coverage 8 a.m. to 8 p.m. Eastern time and let... Cut off foot of panty hose and insert dry long grain rice and tie the ends or Basic Option Substance! Cosmetic procedure cover a breast augmentation is considered not medically necessary 250 cc rice. Panty hose and insert dry long does blue cross blue shield federal cover breast augmentation rice and tie the ends do not cover,... Improve the appearance of your breasts they are responsible for processing claims and providing customer Service to members! For patients insert dry long grain rice and tie the ends however many plastic surgeons offer options! Breast II and Other Special Features, 5 ( I ) and not medically necessary - & _ [ `... Is an inadequate indication for implant removal! PWg GUb971IXsH '' $ I= $ QDG after surgery, which a! Are not medically necessary preferred name and your pronouns & mGI Medical services supplies! Any unexpected treatment that may be required after surgery, which gives peace... In 2023 have no success getting breast implants for `` cosmetic '' purposes and Lipectomy are considered cosmetic and medically! Offer financing through an outside financing, the most popular being CareCredit for care.: Cut off foot of panty hose and insert dry long grain and. No insurance coverage is available: Substance does blue cross blue shield federal cover breast augmentation treatment & ResourcesLearn more about Substance treatment. And not medically necessary for all applications if I have health complications related to my breast implants surgery by!
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