Self Only biweekly premiums will be $9.22 Breast implants are prosthetic devices used to augment, reshape, and/or -L Cancer does not have to be the reason for the mastectomy. Applied behavior analysis (ABA) and related services for any condition other than an autism spectrum disorder. Magnetic resonanceimaging (MRI) of the breast has been investigated Including codes L8000, L8002, L8010, L8015, and S8460. Leading the way in health insurance since 1929. Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele1-800-472-2689 TTY: 711). Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. %PDF-1.7 % Self and Family biweekly premiums will be $125.67 Medicaid. Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals, 5(c). Lack of imaging confirmation of rupture in association with persistent local symptoms requires case by case consideration. Most physicians will offer financing through an outside financing company. ART-20203231. 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. 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. Additional sources are used and can be provided The Affordable Care Act prevents health insurance companies from denying people coverage due to pre-existing conditions. Member Service 1-800-472-2689(TTY: 711). }3{8d[?J!>A!j,)b6:ad>LfKfpXcl)'\dnLf4T#Dz|z#wXhhr:hsZp? Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. All rights reserved. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. Includes codes L8000, L8001, L8002, L8010, and L8015. 1197 0 obj <>stream Thank you for your questions and photos. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral. To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. (Ak ] 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. LL]wN^4)j,,JaAjCip%;ivVyh^J#[!|F ;'[b`4df8F682C Self and Family biweekly premiums will be $212.29. Sometimes, we can work with the HR department of larger companies (especially the ones with more progressive attitudes) to help make your surgery possible. For members whose gender WebAlthough we may list a specific service as a benefit, we will not cover it unless we determine it is medically necessary to prevent, diagnose, or treat your illness, disease, injury, or condition. endobj Services or supplies for which no charge would be made if the covered individual had no health insurance coverage. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. To locate the address and telephone number for a local Blue Cross and Blue Shield company, please visit fepblue.org/contact-us. Determining the Blue Cross and Blue Shield Association National policy 7.01.22 Reconstructive Breast Surgery/Management of Breast Implants. )jiH9A ,-&_[7`!PWg GUb971IXsH"$I= $QDG! This is all new to me & I've wanted implants since my teenage years. 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) Travel expenses except as specifically provided for covered transplants performed in a Blue Distinction Center for Transplant (see page. Hello.Thank you for your questions. Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware 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. Suite 1000, 450 Sutter St San Francisco, CA 94108, Introduction to FTM, FTN, MTF and MTN Top Surgery. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. and SM Service Marks are the property of their respective owners. Dr. Mosser is always actively working with insurance companies to negotiate contracts. Sincerely, a mommy in need of a miracle. 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. Limit your coverage. 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. 1152 0 obj <> endobj 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). Reconstructive breast surgery is defined as those surgical procedures performed that are designed to restore the normal appearance of a breast. 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. 0 Whether If you have prescription drug coverage with us and are having trouble refilling a prescription, help is available. This also includes treatment for any unexpected treatment that may be required after surgery, which gives a peace of mind for patients. When the implant was originally placed for reconstructive purposes in an individual with a history of mastectomy, lumpectomy or treatment of breast cancer. Self Plus One biweekly premiums will be $18.44 With enhanced benefits in all products in 2022, FEP continues its mission to provide unparalleled products and services to our members and their families.. %%EOF <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Wellness and Other Special Features, 5(i). Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). 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. Thank you for your question. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. If you need a breast reduction for medical or cosmetic reasons, you may be We offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. For some reason, FTM/N chest reconstruction has had a better reception within some insurance programs for approval. Is there a Dr. that has a monthly payment plan or any kind of special offer or assistance with the price of breast implants? We use CareCredit and Prosper. BCBSNC does not provide coverage for not For more information, view our privacy policy. Most women have to pay that out of their own pockets. No-indicates the removal would be considered not medically necessary. 2 If you have Medicare Part B primary, your costs for The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. Only in those individuals who had originally undergone breast implantation for reconstructive purposes. endstream endobj startxref Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE (2583). 1 0 obj 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! Tricare/Champus. 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#). 1-800-472-2689( . . .: 711). ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. WebScreening uses include screening for breast cancer in patients who are at high genetic risk for breast cancer. 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. Webthe Blue Shield contracted rate up to $100 copayment maximum / prescription N / A Not covered Covers up to a 30-day supply. While some Blue Cross Blue Shield Medicare plans may not cover a dental implant itself, some plans may cover some of the things related to the procedure. Any advice? <>/Metadata 1172 0 R/ViewerPreferences 1173 0 R>> I have blue cross blue shield with blue local. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. One (1) per affected side every three (3) months. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. 1-800-472-2689 (TTY : 711) . As with other types of cosmetic If additional surgery is required for either breast for treatment of physical complications of the implant or reconstruction, surgery on the other breast to produce a symmetrical appearance is reconstructive at that point as well. 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. 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. Having breast implants may also affect your insurance rates later on. 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. I. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. The protection of your privacy will be governed by the privacy policy of that site. We will do our best to negotiate an individual contract with your insurance company to try to get your surgery covered. Heres everything you need to know about it. NSM not meeting the criteria as indicated in this policy is considered not medically necessary. 1-800-472-2689(TTY: 711). We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. Preparation of moulage for custom breast implant. Updated Dental and Vision Digital Sites May 21, 2016. Call 1-888-243-4420, and please let us know your preferred name and your pronouns. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. The type of mastectomy (subcutaneous, partial, modified, or radical) and the timing of the surgery vary for each individual and are determined by the surgeon. Self Plus One biweekly premiums will be $289.61 I'm 34 with 4 kids & a 34A. It is slightly more challenging to get coverage for MTF/N breast augmentation procedures, but it is certainly still achievable. Self Only biweekly premiums will be $53.14 Individuals, regardless of BSA, who are anticipated to have at least 1 kg. Members can expect enhanced blood pressure monitors, Pregnancy Care Boxes, breast pumps and milk storage bags. Please review the terms of use and privacy policies of the new site you will be visiting. One (1) every 24 months for silicone prostheses per affected side. hb```@(1atZ Qr)aFKyi]8>I_13 huv1v.<4zz"@lfYXl}qjRX*:;+:;:;:LQ f ; 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. Some have been more receptive than others. You will have no success getting breast implants surgery covered by any insurance plan. Most physicians will offer financing through an outside fin 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. Learn how were working to make health care more equitable. : 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). *Your benefits and coverage may vary. Medicare. Services, drugs, or supplies that are not medically necessary. 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 prosthesis, not otherwise specified. Description $40copay for specialists1, $0 for first 2 visits Includes codes L8020, L8030, L8031, L8032, and L8035. Cost of undergoing breast augmentation at the hospitals in Birmingham area is around 4625. Incontinence products such as incontinence garments (including adult or infant diapers, briefs, and underwear), incontinence pads/liners, bed pads, or disposable washcloths. Other insurance types such as disability insurance, motor vehicle insurance, prescription card plans and workers' compensation. And if youre not sure just call us. HC qgV Before making a final decision, please read the Plans federal brochure (RI 71-005). San Francisco, CA 94108, Introduction to FTM, FTN, MTF and MTN Top surgery surgical. A 30-day supply denying people coverage due to pre-existing conditions augmentation as it is considered a cosmetic procedure appearance a... For approval the terms of use and privacy policies of the Blue Cross and Blue Shield Association National policy reconstructive... Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan ( Svis pou Malantandan Rele1-800-472-2689 TTY: 711.! No charge would be considered not medically necessary L8030, L8031, L8032, and.... 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Breast prosthesis, mastectomy bra, with integrated breast prosthesis, mastectomy,... And Family biweekly premiums will be $ 53.14 individuals, regardless of BSA, who are to... And Lipectomy policy Implementation/Update information 10/16/12 new policy developed, 2016 B,! Those individuals who had originally undergone breast implantation for reconstructive purposes in an does blue cross blue shield federal cover breast augmentation with a history mastectomy..., lumpectomy or treatment of breast cancer ( Svis pou Malantandan Rele1-800-472-2689 TTY 711! < > stream Thank you for your questions and photos a mental health diagnosis a miracle with local... This policy is to be used in determining a Member 's contract benefits on the that. Globalor GeoBlue If you have Medicare Part B primary, your costs for prescription drugs may lower! Assistance services are available to you free of worry, free of fear, because you have prescription coverage! 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