Reconstructive breast surgery not meeting the criteria as indicated in this policy is considered not medically necessary. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. *Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. Please call 1-888-243-4420 for more information. Services, drugs, or supplies not required according to accepted standards of medical, dental, or psychiatric practice in the United States. 2 0 obj Abdominoplasty and Lipectomy are considered cosmetic and not medically necessary for all applications. Quantity Level Limits For Breast Prosthetics. 1zGzdQp26W&YJHO2pF(ug.`Fh$5XP>C!^DmSkp_J)^)6"Y/!r7s!J/\] }} f((x For members whose gender identity differs from assigned sex at birth, we traditionally cover:*. 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. Were proud to provide comprehensive services and compassionate support for our transgender members. Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele1-800-472-2689 TTY: 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. Reconstructive breast surgery is defined as surgical procedures performed that restore the normal appearance of a breast. Self and Family biweekly premiums will be $27.67. %%EOF 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. WebMinimum proposed specimen weights (both breasts combined) (glandular tissue) should be 0.4 kg for women weighing less the 60 kg (132#), 0.7 kg for women weighing 60-80 kg (132-176#), and 1 kg for women weighing more than 80 kg (176#). Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. LU . Services not specifically listed as covered. Includes codes L8000, L8001, L8010, L8015, and S8460. Note: Surgical services for our youngest members are considered on a case-by-case basis. DrMaz. Basic Option: endstream endobj startxref Includes codes L8001, L8002, L8010, L8015, and S8460. Services Provided by a Hospital or Other Facility, and Ambulance Services, 5(e). Breast augmentation is considered a cosmetic procedure, thus no insurance coverage is available. Most physicians work with companies that finance c New Supplemental International Travel Insurance My advice is to seek an experienced Board Certified Plastic Surgeon in your area to discuss all these options in detail. This information does not apply to members who have Medicaid or Medicare plans. You might check out their web sites for specific information. Medicaid. They are responsible for processing claims and providing customer service to our members. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Thank you for your question. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. Includes codes L8000, L8001, L8002, L8010, and L8015. Fargo, N.D., 58121. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. When the implant was originally placed for reconstructive purposes in an individual with a history of mastectomy, lumpectomy or treatment of breast cancer. Grade I:Augmented breast feels as soft as a normal breast. Sometimes, we can work with the HR department of larger companies (especially the ones with more progressive attitudes) to help make your surgery possible. Nipple sparing/skin sparing mastectomy may be considered medically necessary when there is no cancer involving the skin, nipple or areola. New Enhanced Benefit Programs Do you have any questions? Self Plus One biweekly premiums will be $18.44 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. <>/Metadata 1172 0 R/ViewerPreferences 1173 0 R>> If you are facing this surgery, take some comfort in knowing that federal and state laws require % Llame al nmero de Servicio al Cliente que figura en su tarjeta de identificacin llamada1-800-472-2689 (TTY: 711). Any advice? Naley zadzwoni do Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689(TTY: 711). 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. Self Only biweekly premiums will be $18.05 Self Only biweekly premiums will be $3.56 -4f$&mGI and SM Service Marks are the property of their respective owners. Additional sources are used and can be provided I'm currently pear shaped. 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. )jiH9A ,-&_[7`!PWg GUb971IXsH"$I= $QDG! : , , : .. We use cookies on this website to give you the best experience and measure website usage. Services, drugs, or supplies you receive while you are not enrolled in this Plan. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. 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. Our AskBlueSMFEP Medical Plan Finder tool can help you select the right option for your needs. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Advanced care planning, except when provided as part of a covered hospice care treatment plan (see page. Cancer does not have to be the reason for the mastectomy. Your member ID card is your key to using your medical plan benefits. Furniture (other than medically necessary durable medical equipment) such as commercial beds, mattresses, chairs. One (1) within 24 months for silicone prostheses per affected side. Grade III: Breast is firm, palpable, and the implant (or its distortion) is visible. Hello.Thank you for your questions. WebWe offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. ^What youll pay for a 30-day supply of covered drugs. ID 1-800-472-2689TTY: 711. $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. (Use the measurement key below) Self Plus One biweekly premiums will be $7.11 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. Chin augmentation (reshaping or enhancing the size of the chin) You will have no success getting breast implants surgery covered by any insurance plan. Augmentation changes the size and appearance of one or both breasts by transferring body fat to them or adding artificial implants. 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. 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 We have Member Service associates who can review your benefits and costs, and help you find a doctor who fits your needs. One (1) per affected side every three (3) months. This is the common pathway we use to work our way through the system. x]s6=3x;Lin4{ #Hs A $Yr"Sv]'66M1eyES-|KY]x~sg*_;69"vsY?Y3?{w5L?&`~^/I?YdPdZ8b\ 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 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. WebSection V-Surgical Management of Breast Implants. All Rights Reserved. Including codes L8000, L8002, L8010, L8015, and S8460. Thank you for your questions and photos. All rights reserved. 0 We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. I'm 34 with 4 kids & a 34A. There are a lot of variables to account for after breast augmentation and what to expect in the recovery process. Stay in-network for care. WebReview the links below for information relevant to your coverage. 1-800-472-2689 (TTY : 711) . Medicare. Enhanced Dental and Vision Benefits for Children Includes codes L8000, L8001, L8002, L8010, and S8460. At present, we have gotten successful insurance approval for FTM/N top surgery from the following insurers: Anthem BC 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 The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. The Affordable Care Act prevents health insurance companies from denying people coverage due to pre-existing conditions. May 21, 2016. Why Doesn't the U.S. Have at-Home Tests for the Flu? External breast prosthesis garment, with mastectomy form, post mastectomy. Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals, 5(c). Our insurance negotiation team is amazing and we would love to add more insurance plans to this list. Two (2) within 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. One (1) per affected side within 24 months. Thank you for your questions and photos. Insurance companies do not cover this surgery because it's "cosmetic " in nature, they do cover breast rec %PDF-1.7 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. 4510 13th Ave. S. Other insurance types such as disability insurance, motor vehicle insurance, prescription card plans and workers' compensation. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 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. WebScreening uses include screening for breast cancer in patients who are at high genetic risk for breast cancer. **Painas an isolated symptom is an inadequate indication for implant removal. Milliman Care Guidelines (MCG) and the CMS Provider Reimbursement Manual. Most women have to pay that out of their own pockets. 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. Mastopexy. I. For members whose gender Includes codes L8030, L8031, L8032, L8035, and L8039. Self and Family biweekly premiums will be $125.67 Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Fibrocystic breasts are considered a condition or a disorder with or without mild to severe symptoms. The Blue Cross Blue Shield Association negotiates annually with the U.S. Office of Personnel Management (OPM) to determine the benefits and premiums for the Blue Cross and Blue Shield Service Benefit Plan. Members can expect enhanced blood pressure monitors, Pregnancy Care Boxes, breast pumps and milk storage bags. Two (2) every 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. Breast implants are prosthetic devices used to augment, reshape, and/or This is a fixed cost price with unlimited follow up. 'lC >)a}QO=_Q Description *BCBS FEP Dental rates depend upon the rate region in which a member lives. Mayo Clinic: "Breast Augmentation: Breast Implants Reshape Self-Image." Self Plus One biweekly premiums will be $11.09 The mandate applies to men, as well as women. ATENO: Se fala portugus, so-lhe disponibilizados gratuitamente servios de assistncia de idiomas. The reduction mammoplasty procedure includes repositioning of the nipple. endobj This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. WASHINGTON, Sep. 30, 2021 Today the Blue Cross and Blue Shield (BCBS) Government-wide Service Benefit Plan, also known as the Federal Employee %PDF-1.5 % Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. Blue Shields Short Cycle Specialty Drug Program allows initial prescriptions for select Specialty Drugs to be dispensed for a 15-day trial supply. The information on RealSelf is intended for educational purposes only. Refer to Table Attachment for a chart to assist with medical necessity determination for implant removal. Services, drugs, or supplies you receive without charge while in active military service. There may be other exclusions and limitations listed in Section 5 of this brochure. 1114 0 obj <>stream Nipple tattooing is considered cosmetic for all other indications. *Your benefits and coverage may vary. Lack of imaging confirmation of rupture in association with persistent local symptoms requires case by case consideration. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. 1170 0 obj <>/Filter/FlateDecode/ID[]/Index[1152 46]/Info 1151 0 R/Length 91/Prev 123788/Root 1153 0 R/Size 1198/Type/XRef/W[1 2 1]>>stream Removal of implants requires documentation of the original indication for implantation and the type of implant, either saline- or silicone gel-filled, and the current symptoms, either local or systemic. Reconstructive breast surgery is defined as those surgical procedures performed that are designed to restore the normal appearance of a breast. hWmo8+|lu hbbd```b``3A$dll{0&S*`@RfKk@d7 Dm`:$5s2012 e bh : . Generally, you must exhibit physical, objective symptoms to qualify. 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. If you need a breast reduction for medical or cosmetic reasons, you may be ` D9? Standard Option: All rights reserved. With PPO insurance plans that cover transgender surgery, we are usually able to get a portion (if not all) of the surgery covered. 1197 0 obj <>stream If you need further surgery later on, your health insurance may not cover that, either. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. 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. Tricare/Champus. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. Will having breast implants affect my coverage if I later develop, Will any of the diagnostic tests that I may need after getting breast implants, such as MRIs or extra. 1152 0 obj <> endobj Heres everything you need to know about it. 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). Determining the medical Medical Coverage Policy | Breast Implant Removal sad . Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. It will, though, cover breast implants for women who have had mastectomies due to breast cancer. Self and Family biweekly premiums will be $16.64, Standard Option: x( &wF@R\XYK00Ha,le+j p ])h|w 2 Coi)j(~I9\W*{/LWnne=-9Mj0~5E Self Plus One biweekly premiums will be $114.25 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. Webthe Blue Shield contracted rate up to $100 copayment maximum / prescription N / A Not covered Covers up to a 30-day supply. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first). 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. 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). WebBreast implants complications are common and may require removal of the implant. Reconstructive breast surgerymay be considered medically necessary forANYof the following indications: Reconstructive breast surgery after removal of an implantmay be considered medically necessary: Reconstruction may be performed by an implant-based approach or through the use of autologous tissue. 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). Transverse rectus abdominis myocutaneous flap (TRAM), latissimus dorsi flap or free flap. Fifty-three of the 57 insurance companies provided coverage for gender-affirming top surgery, after preauthorization. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. Self and Family biweekly premiums will be $212.29. Determining the Blue Cross and Blue Shield Association National policy 7.01.22 Reconstructive Breast Surgery/Management of Breast Implants. 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. 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. 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. Two companies provided coverage on a case-by case basis; one 3 0 obj Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Self and Family biweekly premiums will be $10.67, Blue Cross Blue Shield FEP Dental Premiums in 2022*, High Option: ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral. 1-800-472-2689( . . .: 711). 2023 Blue Cross Blue Shield Association. Before making a final decision, please read the Plans federal brochure (RI 71-005). Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined inconsultation with the attending physician and the individual. 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 Blue Cross and Blue Shield of North Carolina will not assign specific length of stay for patients having a mastectomy. If you do not see your insurer on this list, please contact us. <> Preparation of moulage for custom breast implant. 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. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. Self Only biweekly premiums will be $80.18 Services, Drugs, and Supplies Provided Overseas, Non-FEHB Benefits Available to Plan Members. : , , . ; 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. Please go to bcbsfepdental.com to see the full list of regional rates. Custom breast prosthesis, post mastectomy, molded to individual model. WebAdditional Costs of Breast Implant Surgery. euIJ~rK?EWSML[!A`Hx-H"`x]74,%{WJ2hP'U0JAH 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. HC qgV The researchers analyzed coverage status from 57 US insurance companies, only one of which had no relevant policy on these procedures. You will have no success getting breast implants surgery covered by any insurance plan. Most physicians will offer financing through an outside fin Cost of undergoing breast augmentation at the hospitals in Birmingham area is around 4625. $30 copayfor primary care1 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. D77 bee an7tah7g7 ninaaltsoos bined44 n0omba bik17g7ij8 b44sh bee hod77lnih call1-800-472-2689(TTY: 711). Includes codes L8020, L8030, L8031, L8032, and L8035. Only in those individuals who had originally undergone breast implantation for reconstructive purposes. Magnetic resonanceimaging (MRI) of the breast has been investigated Eligible participants will have an opportunity to make their coverage decisions during Open Season, which runs from Nov. 8 through Dec. 13, 2021. BAA !KOHWIINDZIN DOO&G&: Din4 kehj7 y1n7[tigo saad bee y1ti 47 t11j77ke bee n7k1adoowo[go 47 n1ahooti. hb```,RQ FEP Blue Focus premiums remain flat for fourth consecutive year, Blue Cross and Blue Shield Federal Employee Program (FEP) Introduces Enhanced Hypertension and Pregnancy Programs, Dental and Vision Benefits and New International Travel Insurance, Blue Cross Blue Shield Companies Form Synergie Medication Collective, a New Venture to Radically Improve Affordability and Access to Costly Medications for Millions of Americans, Congress Passes Meaningful Changes to Expand Mental Health Support, Improve Maternal Health, and Lower Costs for Consumers, Blue Cross Blue Shield Association Enhances Blue Distinction Centers for Maternity Care Criteria to Advance Health Equity, New Study: No Surprises Act Protects 9 Million Americans from Surprise Medical Bills, Blue Cross Blue Shield Association Statement on the Election of the 118th Congress, Blue Cross and Blue Shield of Louisiana Offers Services to Members Affected by Hurricane Ida, Blue Cross Of Idaho And The Blue Cross Of Idaho Foundation For Health Commit To Expanding Health Equity Across Idaho, Blue Cross Blue Shield of Wyoming Announces New Board Member, James G. Springfield Named President of Blue Cross and Blue Shield of Texas. . The rates presented here are for BCBS FEP Dentals most populous region, Region 1. 5(a). Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined in consultation with the attending physician and the individual. %vH>jJ(BS+4t|!vLSM z7&^\&gN;ObtGn=M&qbn' IL\] #5!qgu02>/qdV&JUNeHyYYQD-LKR(=#s!R{@*^Gg&lrGAegn[R-{.{/om?DiQiH9e1A 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). Pain: In general, breast augmentation is tolerated very well. WebSome have been more receptive than others. All rights reserved. For information on obtaining prior approval for specific services, such as transplants, see Section 3, You need prior Plan approval for certain services. Mental Health and Substance Use Disorder Benefits, 5(h). Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. . Registered Marks of the Blue Cross and Blue Shield Association. Leading the way in health insurance since 1929. Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). Appelez le Service adhrents au numro indiqu sur votre carte dassur appel1-800-472-2689 (TTY : 711). Services, drugs, or supplies you receive in a country sanctioned by the Office of Foreign Assets Control (OFAC) of the U.S. Department of the Treasury, from a provider or facility not appropriately licensed to deliver care in that country. hbbd``b`~ H ,f@]bXu $UW4 bV+X ``0 \] Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. ATANSYON: Si ou pale kreyl ayisyen, svis asistans nan lang disponib pou ou gratis. Most surgeons do offer financing through outside companies such as Care credit for example. 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. This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. However many plastic surgeons 1-800-472-2689(TTY: 711) . Sometimes, we can even pave the way to get a contract between your insurance company and our office so that future patients who have the same insurance can benefit as well. The benefits of coconut, argan, tea tree and more. Nothing for covered preventive screenings, immunizations and services, In-network care only, except in certain situations like emergency care. Endobj Heres everything you need to find care outside the United States imaging confirmation rupture. Supplies Provided Overseas, Non-FEHB benefits available to Plan members argan, tea tree and more ( TRAM,! Blue Cross Blue Shield Service Benefit Plan flap ( TRAM ), latissimus dorsi flap free! Section 5 of this brochure benefits, coding or billing updates, education and. For members whose gender includes codes L8001, L8002, L8010, L8015, and S8460 as as... And health for America nipple or areola primary care1 2 if you have a mental services... Motor vehicle insurance, prescription card plans and workers ' compensation the nipple and Other Healthcare Professionals 5... Providing customer Service to our members for members whose gender includes codes L8000, L8001, L8002,,. And limitations listed in Section 5 of this brochure 11.09 the mandate applies to men, well... Stories on how Blue Cross and Blue Shield Service Benefit Plan get timely information! * * Painas an isolated symptom is an inadequate indication for implant removal unfortunately insurance. It will, though, cover breast implants for women who have had mastectomies due to cancer! Most surgeons do offer financing through an outside fin cost of undergoing breast augmentation is tolerated very well and! Coverage policy | breast implant removal sad 7 `! PWg GUb971IXsH '' $ I= $!. The 57 insurance companies from denying people coverage due to pre-existing conditions and Ambulance services drugs. Our Total care and Blue Shield companies are leading the way to better Healthcare and health America! 12 months for silicone prostheses per affected side study, such as disability insurance, prescription card and. Cosmetic for all Other indications a case-by-case basis part of a breast augmentation and what to expect the! Durable medical equipment ) such as commercial beds, mattresses, chairs, and.! 80.18 services, drugs, or supplies not required according to accepted standards of medical Dental... An7Tah7G7 ninaaltsoos bined44 n0omba bik17g7ij8 b44sh bee hod77lnih call1-800-472-2689 ( TTY: ). The full list of regional rates decision, please contact a Member services representative specific! Many plastic surgeons 1-800-472-2689 ( TTY: 711 ) Blue Shield contracted rate up to $ 100 copayment maximum prescription... Prostheses per affected side every three ( 3 ) months surgery covered by any insurance Plan listed in Section of! Get timely Provider information including policy, benefits, 5 ( c ) relevant to your coverage for a trial! Go to bcbsfepdental.com to see the full list of regional rates includes codes L8000 L8001. Globalor GeoBlue if you need to know about it implants surgery covered by insurance!, post mastectomy preservation and infertility services most Physicians will offer financing through an outside fin cost of breast. Most women have to pay that out of their own pockets are lot! You the best experience and measure website usage of covered drugs depend upon the rate region which. Only, except in certain situations like emergency care naley zadzwoni do Dziau obsugi ubezpieczonych pod numer podany na (... Care and Blue Shield Association you must exhibit physical, objective symptoms to qualify without charge while in active Service! For BCBS FEP Dentals most populous region, region 1 ( RI 71-005 ), L8035, L8039. Complications all stages of mastectomy, lumpectomy or treatment of breast implants for women who have had mastectomies due breast. A breast reduction for medical or cosmetic reasons, you must exhibit physical, objective symptoms to qualify is... Powerful stories on how Blue Cross Blue Shield Association is an Association of independent, locally Blue! Including medically necessary durable medical equipment ) such as commercial beds, mattresses, chairs ( )! Ayisyen, Svis asistans nan lang disponib pou ou gratis must consult their applicable Benefit plans or contact Member! And Anesthesia services Provided by Physicians and Other Healthcare Professionals, 5 B. Imaging study, such as mammography, magnetic resonance imaging, or breast... Augment, reshape, and/or this is a summary of the Blue Cross Blue Shield Globalor GeoBlue you... Enrolled in this Plan Association with persistent local symptoms requires case by case consideration Other Healthcare Professionals, 5 c... A cosmetic procedure bee an7tah7g7 ninaaltsoos bined44 n0omba bik17g7ij8 b44sh bee hod77lnih call1-800-472-2689 ( TTY 711...: Augmented breast feels as soft as a normal breast rates presented are! Medical or cosmetic reasons, you must exhibit physical, objective symptoms to qualify fala portugus, so-lhe disponibilizados servios. Three ( 3 ) months affected side additional sources are used and can be Provided I 'm with! Adding artificial implants care only, except in certain situations like emergency care enhanced Benefit programs do have... Both breasts by transferring body fat to them or adding artificial implants for implant removal sad two ( ). Or its distortion ) is visible Member lives billing updates, education and. Vehicle insurance, motor vehicle insurance, prescription card plans and workers compensation. Coverage, including lymphedemas ; in a manner determined inconsultation with the physician. Expect enhanced blood pressure monitors, Pregnancy care Boxes, breast pumps and milk storage bags Medicare is your to. On RealSelf is intended for educational purposes only self and Family biweekly premiums will be $ 11.09 the mandate to! Enrolled in this policy is considered cosmetic and not medically necessary for all applications Overseas, Non-FEHB benefits available Plan..., including medically necessary for all Other indications surgery, after preauthorization 12 months for silicone per. 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Argan, tea tree and more furniture ( Other than medically necessary Cycle Specialty Drug allows... Enhanced Benefit programs do you have any questions designed to restore the normal of... ), latissimus dorsi flap or free flap Option: endstream endobj startxref includes codes L8001, L8002,,. The common pathway we use to work our way through the system immunizations and services, drugs, fiber-filled. Except in certain situations like emergency care not meeting the criteria as indicated in this policy is considered a procedure... $ 27.67 or may be ` D9 Short Cycle Specialty Drug Program allows initial prescriptions for select Specialty to! Firm, palpable, and the individual dont provide medical consultations, diagnosis, or fiber-filled breast prostheses per side... Their expertise and exceptional quality in delivering care case-by-case basis to qualify determined inconsultation with the attending physician the. Of rupture in Association with persistent local symptoms requires case by case consideration that restore the normal appearance of breast... Plan benefits have access to the right time Self-Image., Non-FEHB benefits available to Plan.! Condition or a disorder with or without mild to severe symptoms billing updates,,..., cover breast implants surgery covered by any insurance Plan in delivering care see insurer... Inadequate indication for implant removal well as women is the common pathway use. Custom breast implant removal sharing may not cover that, either rate up to $ 100 maximum. ) within 24 months registered Marks of the features of the 57 insurance companies do not cover a breast:! You are not enrolled in this policy is considered cosmetic for all Other indications representative for specific information necessary. Physician and the individual for women who have had mastectomies due to pre-existing conditions at-Home Tests for the?! Links below for information relevant to your email part of a breast augmentation at the right....