ATENO: Se fala portugus, so-lhe disponibilizados gratuitamente servios de assistncia de idiomas. 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. Chin augmentation (reshaping or enhancing the size of the chin) Member Discounts Take advantage of member-only discounts on health-related products and services. 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. 0 Why Doesn't the U.S. Have at-Home Tests for the Flu? There are a lot of variables to account for after breast augmentation and what to expect in the recovery process. **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. Naley zadzwoni do Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689(TTY: 711). 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. Dear Geneseo,Thank you for your post. Medicare Advantage members, please call 877-817-0493 all other members please call, 877-817-0477. The pain should be related to the Baker classification or a diagnosis of rupture. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. endobj hbbd```b``3A$dll{0&S*`@RfKk@d7 Dm`:$5s2012 e bh No-indicates the removal would be considered not medically necessary. Includes codes L8001, L8002, L8010, L8015, and S8460. If I have health complications related to my breast implants, will the necessary treatment or surgery be covered? Services not specifically listed as covered. There may be other exclusions and limitations listed in Section 5 of this brochure. Medicare. My health insurance is an HMO plan. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 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. Reconstructive breast surgery is defined as those surgical procedures performed that are designed to restore the normal appearance of a breast. Includes codes L8000, L8001, L8002, L8015, and S8460. Hi,Thanks for your question. FEP Blue Focus: Less than or equal to 12 months post mastectomy. Check out the changes and updates to our plan in 2023. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. Breast augmentation is considered a cosmetic procedure, thus no insurance coverage is available. Most physicians work with companies that finance c 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. 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. Any advice? 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. Services, Drugs, and Supplies Provided Overseas, Non-FEHB Benefits Available to Plan Members. Services, drugs, or supplies you receive while you are not enrolled in this Plan. : . Although cosmetic procedures are never covered by insurance, certain procedures related to your surgery may be What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Cancer does not have to be the reason for the mastectomy. 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. Regardless, we work extremely hard to help our patients navigate the insurance system. Standard Option: ID 1-800-472-2689TTY 711). Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele1-800-472-2689 TTY: 711). Contracted insurance plans. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. Thank you for your questions and photos. WASHINGTON, Sep. 30, 2021 Today the Blue Cross and Blue Shield (BCBS) Government-wide Service Benefit Plan, also known as the Federal Employee Program (FEP), announced 2022 benefits available to eligible participants in the Federal Employees Health Benefits (FEHB) Program and the Federal Employees Dental and Vision Insurance Program (FEDVIP). 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. HZjz:|QkM]h]\ ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstutzung zur Verfugung. 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. endstream endobj 1071 0 obj <>stream 4510 13th Ave. S. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. 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. Please see Table Attachment for quantity limits. Leading the way in health insurance since 1929. The Affordable Care Act prevents health insurance companies from denying people coverage due to pre-existing conditions. Only in those individuals who had originally undergone breast implantation for reconstructive purposes. : , . 1152 0 obj <> endobj 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. Personal comfort items such as beauty and barber services, radio, television, or phone. Limit your coverage. Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals, 5(c). Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag1-800-472-2689(TTY: 711). Blue Cross Blue Shield FEP Vision Premiums in 2022: High Option: Internal Medical Policy Committee 11-14-2019 incorporate Table into policy; removal of procedure code 19304; Add Procedure code L8033, Internal Medical Policy Committee 11-19-2020 Criteria updated, Internal Medical Policy Committee 11-23-2021 Annual Review, no changes in criteria, Fargo (Headquarters) They are responsible for processing claims and providing customer service to our members. Surgery on the Contralateral Breast to Produce Symmetry. (ID Card) 1-800-472-2689(TTY: 711). WebScreening uses include screening for breast cancer in patients who are at high genetic risk for breast cancer. Step 1: Cut off foot of panty hose and insert dry long grain rice and tie the ends. 4 0 obj endstream endobj 1153 0 obj <. For more information, view our privacy policy. The researchers analyzed coverage status from 57 US insurance companies, only one of which had no relevant policy on these procedures. With PPO insurance plans that cover transgender surgery, we are usually able to get a portion (if not all) of the surgery covered. New Supplemental International Travel Insurance ])h|w 2 Coi)j(~I9\W*{/LWnne=-9Mj0~5E You can also visit our Mental Health Resource Center to learn more. UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. One (1) within 24 months for silicone prostheses per affected side. Self Only biweekly premiums will be $9.22 Your member ID card is your key to using your medical plan benefits. This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. WebWe offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. Lumpectomy is the removal of the breast tumor and surrounding tissue. Insurance companies don't cover breast implants for "cosmetic" purposes. WebMD does not provide medical advice, diagnosis or treatment. Some have been more receptive than others. ! section or contact us directly! Please go to bcbsfepdental.com to see the full list of regional rates. 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. Find out who qualifies for Blue Cross Blue Shield breast reduction coverage. The pain should be related to the Baker classification or a diagnosis of rupture. ATTENTION : si vous parlez franais, des services dassistance linguistique sont disponibles gratuitement. 2 0 obj ATANSYON: Si ou pale kreyl ayisyen, svis asistans nan lang disponib pou ou gratis. pathology, does not constitute an abnormal structure (e.g., cosmetic unilateral, bilateral or asymmetrical saline breast implants) In determining whether or not a procedure is likely to result in more than minimal improvement in appearance, the qualified reviewer will consider both the size and location of the structural abnormality. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. 2020 Blue Cross Blue Shield Association. Fargo, N.D., 58121. External breast prosthesis garment, with mastectomy form, post mastectomy. Updated Dental and Vision Digital Sites Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware of. Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. In most practices, including ours, financing programs are available. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Orthodontic care for malposition of the bones of the jaw or for temporomandibular joint (TMJ) syndrome. Abdominoplasty and Lipectomy are considered cosmetic and not medically necessary for all applications. Surgery on the contralateral breast to produce symmetry not meeting the criteria as indicated in this policy is considered not medically necessary. . Mastectomy for fibrocystic breasts not meeting the criteria as indicated in this policy is considered not medically necessary. Self Only biweekly premiums will be $80.18 Step 2: Place 250 cc of rice on one side and 300 cc on the other side. 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. Other insurance types such as disability insurance, motor vehicle insurance, prescription card plans and workers' compensation. %PDF-1.5 % Do you have any questions? % 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). For members whose gender identity differs from assigned sex at birth, we traditionally cover:*. One (1) per affected side within 24 months. Description 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 We use cookies on this website to give you the best experience and measure website usage. Breast prosthesis, not otherwise specified. 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). Experimental or investigational procedures, treatments, drugs, or devices (see Section 5(b) regarding transplants). Topical Hyperbaric Oxygen Therapy (THBO). Recreational or educational therapy, and any related diagnostic testing, except as provided by a hospital during a covered inpatient stay. (Ak ] Services, drugs, or supplies you receive from noncovered providers. BCBS FEP Vision plans will offer a second eye exam, frame and second pair of lenses when a prescription changes for children aged 13 and under. 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. Services, drugs, or supplies you receive without charge while in active military service. 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. 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. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral. 2023 Blue Cross Blue Shield Association. 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. Nothing for covered preventive screenings, immunizations and services, In-network care only, except in certain situations like emergency care. ID 1-800-472-2689TTY: 711. 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. Most women have to pay that out of their own pockets. The reduction mammoplasty procedure includes repositioning of the nipple. Self and Family biweekly premiums will be $212.29. ART-20203231. 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. <>/Metadata 1172 0 R/ViewerPreferences 1173 0 R>> 1-800-472-2689( . . .: 711). Transverse rectus abdominis myocutaneous flap (TRAM), latissimus dorsi flap or free flap. 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). Were partnering with clinicians to ensure access to care in Massachusetts. Before making a final decision, please read the Plans federal brochure (RI 71-005). Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. *dlVU! (or any amounts you desire). Self Plus One biweekly premiums will be $289.61 Under Basic Option, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care. I. 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 This also includes treatment for any unexpected treatment that may be required after surgery, which gives a peace of mind for patients. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. 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. Breast enlargement procedures, including augmentation mammoplasty, implants, and silicone injections of the breast II. FDA: "FDA Breast Implant Consumer Handbook." : , , : .. Individuals, regardless of BSA, who are anticipated to have at least 1 kg. This document addresses gender affirming surgery (also known as sex affirmation surgery, gender or sex reassignment surgery, gender or sex confirmation **Painas an isolated symptom is an inadequate indication for implant removal. Llame al nmero de Servicio al Cliente que figura en su tarjeta de identificacin llamada1-800-472-2689 (TTY: 711). WebAdditional Costs of Breast Implant Surgery. Determining the medical Medical Coverage Policy | Breast Implant Removal sad . endobj Insurance usually will not cover breast enlargement surgery. Milliman Care Guidelines (MCG) and the CMS Provider Reimbursement Manual. You might check out their web sites for specific information. ***Contractureshave been graded according to the Baker Classification which is outlined below: Grade I: Augmented breast feels as soft as a normal breast. ( RI 71-005 ) 0 R > > 1-800-472-2689 ( TTY: 711 ) de identificacin llamada1-800-472-2689 ( TTY 711... 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