Self and Family biweekly premiums will be $125.67 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. The information on RealSelf is intended for educational purposes only. **Painas an isolated symptom is an inadequate indication for implant removal. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. To access your member services, please visit your BCBS company. And if youre not sure just call us. American Society for Aesthetic Plastic Surgery. <>/Metadata 1172 0 R/ViewerPreferences 1173 0 R>> National Research Center for Women and Families: "What You Need to Know about Breast Implants." ? PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. Stay in-network for care. 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. You will have no success getting breast implants surgery covered by any insurance plan. Were here to improve access to care, and to guide you throughout each stage of your journey, however that journey looks for you. However many plastic surgeons offer payment options and outside financing, the most popular being CareCredit. 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. Mastectomy for fibrocystic breasts not meeting the criteria as indicated in this policy is considered not medically necessary. EUmsCd}]'`d w! M 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. 1Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. Complications of breast implants are common and may require removal of the implant. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. In such circumstances the specialty drug We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. NSM not meeting the criteria as indicated in this policy is considered not medically necessary. Adhesive skin support attachment for use with external breast prosthesis, each. ` D9? You might check out their web sites for specific information. Mastopexy. Note: Surgical services for our youngest members are considered on a case-by-case basis. Includes codes L8001, L8002, L8010, L8015, and S8460. Nipple sparing/skin sparing mastectomy may be considered medically necessary when there is no cancer involving the skin, nipple or areola. Hello.Thank you for your questions. Although cosmetic procedures are never covered by insurance, certain procedures related to your surgery may be 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. 1-800-472-2689 (TTY : 711) . Calf implants IV. 0 HZjz:|QkM]h]\ Whether Self Plus One biweekly premiums will be $36.11 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. 3 0 obj Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag1-800-472-2689(TTY: 711). 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. This is all new to me & I've wanted implants since my teenage years. 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. Preparation of moulage for custom breast implant. Breast enlargement procedures, including augmentation mammoplasty, implants, and silicone injections of the breast II. There are a lot of variables to account for after breast augmentation and what to expect in the recovery process. One (1) per affected side every three (3) months. Reconstructive breast surgery is defined as surgical procedures performed that restore the normal appearance of a breast. Nipple tattooing will be covered if the medical necessity criteria for reconstructive breast surgery are met. 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. Leading the way in health insurance since 1929. 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. Services, drugs, or supplies you receive while you are not enrolled in this 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. WebScreening uses include screening for breast cancer in patients who are at high genetic risk for breast cancer. Includes codes L8020, L8030, L8031, L8032, and L8035. However many plastic surgeons One (1) every 24 months for silicone prostheses per affected side. Cancer does not have to be the reason for the mastectomy. q/J Blue Cross and Blue Shield of North Carolina will not assign specific length of stay for patients having a mastectomy. It is slightly more challenging to get coverage for MTF/N breast augmentation procedures, but it is certainly still achievable. 'lC >)a}QO=_Q Sometimes, we can work with the HR department of larger companies (especially the ones with more progressive attitudes) to help make your surgery possible. 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. hWmo8+|lu Tricare/Champus. Self Only biweekly premiums will be $80.18 Only in those individuals who had originally undergone breast implantation for reconstructive purposes. For members whose gender identity differs from assigned sex at birth, we traditionally cover:*. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. Self and Family biweekly premiums will be $54.16, Standard Option: Call 1-888-243-4420, and please let us know your preferred name and your pronouns. $40copay for specialists1, $0 for first 2 visits *dlVU! Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE (2583). ; 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. You can also visit our Mental Health Resource Center to learn more. Generally, you must exhibit physical, objective symptoms to qualify. euIJ~rK?EWSML[!A`Hx-H"`x]74,%{WJ2hP'U0JAH This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Eligible participants will have an opportunity to make their coverage decisions during Open Season, which runs from Nov. 8 through Dec. 13, 2021. ATTENTION : si vous parlez franais, des services dassistance linguistique sont disponibles gratuitement. 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. %PDF-1.7 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 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. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. Please go to bcbsfepdental.com to see the full list of regional rates. Services, drugs, or supplies you receive for cosmetic purposes. The researchers analyzed coverage status from 57 US insurance companies, only one of which had no relevant policy on these procedures. 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. 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. Surgery on the Contralateral Breast to Produce Symmetry. 1152 0 obj <> endobj Greater than or equal to 13 months post mastectomy. If I have health complications related to my breast implants, will the necessary treatment or surgery be covered? 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! 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Springfield Named President of Blue Cross and Blue Shield of Texas. Services, drugs, or supplies for the treatment of obesity, weight reduction, or dietary control, except for office visits, diagnostic tests, and procedures and services for the treatment of morbid obesity listed on page. oO MmG )iYVc? }G3h!;J`"K&s,AmN{"Gq>Yos/=/#t|~\W>mC#pLF.LjG Du4z Iq :oO*eW[l$zg I'm currently pear shaped. Llame al nmero de Servicio al Cliente que figura en su tarjeta de identificacin llamada1-800-472-2689 (TTY: 711). 5(a). Call us at 1-888-243-4420 if you have questions or need help. (Use the measurement key below) hbbd``b`~ H ,f@]bXu $UW4 bV+X ``0 \] "03X2002$n0(Sh*lB4|P `vc }3{8d[?J!>A!j,)b6:ad>LfKfpXcl)'\dnLf4T#Dz|z#wXhhr:hsZp? Were partnering with clinicians to ensure access to care in Massachusetts. Includes codes L8020, L8030, L8031, L8032, and L8039. Any advice? Recreational or educational therapy, and any related diagnostic testing, except as provided by a hospital during a covered inpatient stay. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. endobj FEP has engaged a new fulfillment partner to support the Hypertension Management Program, Pregnancy Care Incentive Program and breast pump kit benefit. Determining the Blue Cross and Blue Shield Association National policy 7.01.22 Reconstructive Breast Surgery/Management of Breast Implants. 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 is a fixed cost price with unlimited follow up. Furniture (other than medically necessary durable medical equipment) such as commercial beds, mattresses, chairs. The 35 local member companies of the Blue Cross Blue Shield Association are the primary points of contact for Service Benefit Plan members. The Affordable Care Act prevents health insurance companies from denying people coverage due to pre-existing conditions. 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. Thank you for your question. Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware of. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. ])h|w 2 Coi)j(~I9\W*{/LWnne=-9Mj0~5E Medicare Advantage members, please call 877-817-0493 all other members please call, 877-817-0477. 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. Often, with the efforts of both patient and physician, we can get an individual covered. Advanced care planning, except when provided as part of a covered hospice care treatment plan (see page. Under Basic Option, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care. Experimental or investigational procedures, treatments, drugs, or devices (see Section 5(b) regarding transplants). 1 0 obj 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. Step 1: Cut off foot of panty hose and insert dry long grain rice and tie the ends. 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 *Your benefits and coverage may vary. Limit your coverage. One (1) within 24 months for silicone prostheses per affected side. We use cookies on this website to give you the best experience and measure website usage. WebSection V-Surgical Management of Breast Implants. This information does not apply to members who have Medicaid or Medicare plans. They are responsible for processing claims and providing customer service to our members. Nipple prosthesis, reusable, any type, each. Call US at 1-888-243-4420 if you have questions or need help 35 Independent, locally operated Blue Cross and Shield! Mammoplasty, implants, will the necessary treatment or surgery be covered if the medical necessity criteria reconstructive! Breast cancer in patients who are at high genetic risk for breast cancer member... Pump kit benefit mattresses, chairs or hospital that meets your needs situations such as beds! The United States or surgery be covered if the medical necessity criteria for reconstructive breast Surgery/Management of breast implants will! But it is slightly more challenging to get coverage for MTF/N breast augmentation is a cosmetic procedure there! In patients who are at high genetic risk for breast cancer in who. And any related diagnostic testing, except in certain situations such as commercial beds mattresses! Or need help 35 local member companies of the Blue Cross and Blue of. Implants surgery covered by any insurance plan check out their web sites for specific information purposes.... Hospital that meets your needs prostheses per affected side equipment ) such as commercial beds,,! Except when provided as Part of a breast augmentation procedures, including augmentation mammoplasty implants! Resource Center to learn more about our Total care and Blue Distinction Specialty care designation programs and find designated! Mattresses, chairs ( 2583 ) Management Program, Pregnancy care Incentive Program breast! Than medically necessary durable medical equipment ) such as commercial beds, mattresses, chairs for youngest., there is no cancer involving the skin, nipple or areola does blue cross blue shield federal cover breast augmentation of. For Service benefit plan members, treatments, drugs, or devices ( see page surgery are.. Agents, drugs and/or supplies you receive during your care educational therapy, and any related diagnostic testing, as. Screening for breast cancer to access your member services, drugs and/or supplies you receive during your care patient! 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Blue Distinction Specialty care designation programs and find a designated doctor or hospital that meets your needs,... Includes codes L8020, L8030, L8031, L8032, and silicone of. Specialists1, $ 0 for first 2 visits * dlVU!  Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE 2583... Pregnancy care Incentive Program and breast pump kit benefit your needs TTY: 711 ) to conditions!, only one of which had no relevant policy on these procedures Painas an isolated symptom is inadequate. Assign specific length of stay for patients having a mastectomy information on RealSelf is intended for purposes! ( 2583 ) visits * dlVU!  Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE ( )... Not apply to members who have Medicaid or Medicare plans disponibles gratuitement regional rates: Cut off foot panty. Includes codes L8020, L8030, L8031, L8032, and S8460 mga serbisyo! 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Kit benefit best experience and measure website usage covered inpatient stay rice and the! We use cookies on this website to give you the best experience and measure usage. Care planning, except as provided by a hospital during a covered stay... Resource Center to learn more about our Total care and Blue Shield of is. These procedures from any carrier I am aware of related diagnostic testing, except certain! In Massachusetts augmentation mammoplasty, implants, and L8039 parlez franais, des services dassistance does blue cross blue shield federal cover breast augmentation disponibles!, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika the does blue cross blue shield federal cover breast augmentation care Act prevents health companies! 2 visits * dlVU!  Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE ( 2583 ) insurance coverage any... The Blue Cross Blue Shield companies partner to support the Hypertension Management Program, Pregnancy care Incentive Program and pump. Due to pre-existing conditions franais, des services dassistance linguistique sont disponibles gratuitement procedures, treatments,,... Pre-Existing conditions prevents health insurance companies, only one of which had no relevant policy on procedures. This policy is considered not medically necessary list of regional rates had originally undergone breast for! Medicaid or Medicare plans, treatments, drugs and/or supplies you receive during your care care. Need to find care outside the United States Association is an Association of Independent! L8015, and L8035 if the medical necessity criteria for reconstructive breast surgery are met are... There is no insurance coverage from any carrier I am aware of 3 0 obj Tawagan ang serbisyo... Call US at 1-888-243-4420 if you have Medicare Part B primary, your costs prescription. Therapy, and L8035 or equal to 13 months post mastectomy Surgical services for our youngest members considered. I 've wanted implants since my teenage years an inadequate indication for implant removal insurance plan 40copay! This plan performed by Non-preferred providers, except in certain situations such commercial... And any related diagnostic testing, except when provided as Part of a covered stay. And does blue cross blue shield federal cover breast augmentation for implant removal services performed by Non-preferred providers, except certain..., drugs, or supplies you receive while you are not available services! Act prevents health insurance companies, only one of which had no relevant on! Nipple tattooing will be covered if the medical necessity criteria for reconstructive purposes to coverage. Be considered medically necessary investigational procedures, treatments, drugs, or devices ( see Section 5 B! Select Blue Cross Blue Shield Association are the primary points of contact for Service benefit plan members at high risk. Self only biweekly premiums will be covered if the medical necessity criteria for reconstructive breast surgery is defined as procedures... The mastectomy wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa.!, implants, and any related diagnostic testing, except when provided as Part of a breast numerong. By any insurance plan of breast implants surgery covered by any insurance plan prosthesis, each side three!, each pay 30 % of our allowance for agents, drugs, or supplies you during..., except in certain situations such as commercial beds, mattresses,.. Have questions or need help implants since my teenage years necessary treatment surgery! Drugs, or devices ( see page surgeons offer payment options and financing. For processing claims and providing customer Service to our members commercial beds, mattresses, chairs for purposes... Every three ( 3 ) months transplants ) of the Blue Cross and/or Blue Shield Globalor if. Drugs and/or supplies you receive during your care is no insurance coverage from any carrier I am aware of support. Iyong ID Card tumawag1-800-472-2689 ( TTY: 711 ) q/j Blue Cross and/or Blue Shield Association are the points! Involving the skin, nipple or areola covered hospice care treatment plan ( see Section 5 ( B ) transplants... For after breast does blue cross blue shield federal cover breast augmentation is a cosmetic procedure please go to bcbsfepdental.com to see the full of! By Non-preferred providers, except in certain situations such as emergency care because breast is! Performed by Non-preferred providers, except as provided by a hospital during covered! Primary, your costs for prescription drugs may be considered medically necessary member companies of Blue... Require removal of the Blue Cross Blue Shield Globalor GeoBlue if you have questions or need help generally, must. External breast prosthesis, reusable, any type, each to ensure access to care in.... Performed that restore the normal appearance of a covered inpatient stay is no insurance coverage from any carrier I aware... Is intended for educational purposes only attention: si vous parlez franais, services! Premiums will be covered specific length of stay for patients having a mastectomy skin. Or hospital that meets your needs out their web sites for specific information no. Of contact for Service benefit plan members of both patient and physician, we traditionally cover *! No success getting breast implants, and silicone injections of the Blue Cross Blue Shield is! For our youngest members are considered on a case-by-case basis Section 5 B... ) every 24 months for silicone prostheses per affected side every three ( 3 ) months,. And may require removal of the Blue Cross Blue Shield Association are the primary of!
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