endobj However, health insurance companies can: SOURCES: Implant Information Project: "What You Need to Know Before You Get Breast Implants." *BCBS FEP Dental rates depend upon the rate region in which a member lives. Do you have any questions? 7; Often, with the efforts of both patient and physician, we can get an individual covered. All rights reserved. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Most surgeons do offer financing through outside companies such as Care credit for example. 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. EUmsCd}]'`d w! M UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. Fibrocystic breasts are considered a condition or a disorder with or without mild to severe symptoms. 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. Self Plus One biweekly premiums will be $196.13 endstream endobj 1153 0 obj <. Leading the way in health insurance since 1929. Mayo Clinic: "Breast Augmentation: Breast Implants Reshape Self-Image." 2023 Blue Cross Blue Shield Association. There may be other exclusions and limitations listed in Section 5 of this brochure. Mastopexy. External breast prosthesis garment, with mastectomy form, post mastectomy. This document addresses gender affirming surgery (also known as sex affirmation surgery, gender or sex reassignment surgery, gender or sex confirmation At present, we have gotten successful insurance approval for FTM/N top surgery from the following insurers: Anthem BC Implantable breast prosthesis, silicone or equal. The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. Services that do not meet the criteria of this policy will be considered not medically necessary. Self Plus One biweekly premiums will be $114.25 Adhesive skin support attachment for use with external breast prosthesis, each. In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including surgeon's fees, operating room costs and anesthesia)in 2022. National Research Center for Women and Families: "What You Need to Know about Breast Implants." Lack of imaging confirmation of rupture in association with persistent local symptoms requires case by case consideration. Call us at 1-888-243-4420 if you have questions or need help. 2 If you have Medicare Part B primary, your costs for Grade IV: Breast is hard, painful, cold, tender, and distorted. Were proud to provide comprehensive services and compassionate support for our transgender members. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Sincerely, a mommy in need of a miracle. Orthodontic care for malposition of the bones of the jaw or for temporomandibular joint (TMJ) syndrome. Includes codes L8020, L8030, L8031, L8032, and L8039. -4f$&mGI Quantity Level Limits For Breast Prosthetics. 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Springfield Named President of Blue Cross and Blue Shield of Texas. 1-800-472-2689( . . .: 711). And if youre not sure just call us. : , . The following is an outline based on some of these variables:1. For information on obtaining prior approval for specific services, such as transplants, see Section 3, You need prior Plan approval for certain services. One (1) within 24 months for silicone prostheses per affected side. One (1) per affected side every 24 months, One (1) per affected side every 24 months. However many plastic surgeons Self Plus One biweekly premiums will be $36.11 It covers roughly 5.6 million federal employees, retirees and their families out of the more than 8.5 million people who receive their benefits through the FEHB Program. Surgery on the Contralateral Breast to Produce Symmetry. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Services, drugs, or supplies not required according to accepted standards of medical, dental, or psychiatric practice in the United States. Member Discounts Take advantage of member-only discounts on health-related products and services. The Blue Cross Blue Shield Association negotiates annually with the U.S. Office of Personnel Management (OPM) to determine the benefits and premiums for the Blue Cross and Blue Shield Service Benefit Plan. Additional sources are used and can be provided Medicaid. Don't give up hope though because there are several awesome financing companies, including CareCredit, Alphaeon and United Medical Credit. Insurance companies don't cover breast implants for "cosmetic" purposes. The Blue Cross and Blue Shield Service Benefit Plan, also known as the Federal Employee Program (FEP), has been part of the Federal Employees Health Benefits (FEHB) Program since its inception in 1960. Were here to improve access to care, and to guide you throughout each stage of your journey, however that journey looks for you. Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. hbbd```b``3A$dll{0&S*`@RfKk@d7 Dm`:$5s2012 e bh , 1-800-472-2689(: 711). Check our F.A.Q. Contracted insurance plans. 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 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. The reduction mammoplasty procedure includes repositioning of the nipple. We use CareCredit and Prosper. 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 Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. Please see your subscriber certificate for details about your plan coverage. Dear Geneseo,Thank you for your post. This is the common pathway we use to work our way through the system. Systemic symptoms, attributed to connective tissue diseases, autoimmune diseases, etc. Determining the Blue Cross and Blue Shield Association National policy 7.01.22 Reconstructive Breast Surgery/Management of Breast Implants. 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. One (1) per affected side within 24 months. Grade IV: Breast is hard, painful, cold, tender, and distorted. Includes codes L8000, L8001, L8002, L8015, and S8460. Tricare/Champus. This specialized team of clinical experts, mental health experts, and psychiatrists is available for comprehensive support. 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. : 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). 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. If you need a breast reduction for medical or cosmetic reasons, you may be 0 With enhanced benefits in all products in 2022, FEP continues its mission to provide unparalleled products and services to our members and their families.. 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. 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. endstream endobj 1071 0 obj <>stream No-indicates the removal would be considered not medically necessary. WebSome have been more receptive than others. 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. Breast prosthesis, not otherwise specified. BCBSNC does not provide coverage for not To locate the address and telephone number for a local Blue Cross and Blue Shield company, please visit fepblue.org/contact-us. Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware of. Description Custom breast prosthesis, post mastectomy, molded to individual model. 1 0 obj Self Plus One biweekly premiums will be $11.09 This is a fixed cost price with unlimited follow up. **Painas an isolated symptom is an inadequate indication for implant removal. The information on RealSelf is intended for educational purposes only. Additional information about 2022 benefits is available online or by calling the National Information Center. Applied behavior analysis (ABA) services and related services performed as part of an educational program; or provided in or by a school/educational setting; or provided as a replacement for services that are the responsibility of the educational system. Procedure Codes Breast Prosthetics The following breast prosthetics are medically necessary: Breast prosthesis, mastectomy bra. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. $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. Please call 1-888-243-4420 for more information. BAA !KOHWIINDZIN DOO&G&: Din4 kehj7 y1n7[tigo saad bee y1ti 47 t11j77ke bee n7k1adoowo[go 47 n1ahooti. Self Only biweekly premiums will be $127.47 This procedure is most often performed to treat breast cancer. Self and Family biweekly premiums will be $212.29. Two companies provided coverage on a case-by case basis; one If you do not see your insurer on this list, please contact us. 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. May 21, 2016. HMOs. 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. Before making a final decision, please read the Plans federal brochure (RI 71-005). sf%paPEs4J You might check out their web sites for specific information. Reconstructive breast surgery is defined as surgical procedures performed that restore the normal appearance of a breast. %PDF-1.7 % endobj 500 Services, Drugs, and Supplies Provided Overseas, Non-FEHB Benefits Available to Plan Members. Includes codes L8020, L8030, L8031, L8032, and L8035. Basic Option: How Long is Breast Implants Recovery Time? 5(a). 3You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. Dr. Mosser is always actively working with insurance companies to negotiate contracts. Last review: July 2003. Regardless, we work extremely hard to help our patients navigate the insurance system. ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. Self Only biweekly premiums will be $9.22 <> 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). endstream endobj startxref 2005 - 2023 WebMD LLC. Nipple tattooing is considered cosmetic for all other indications. Includes codes L8000, L8001, L8002, L8010, and S8460. Is the common pathway we use to work our way through the system clinical experts, mental health experts and!, please read the Plans federal brochure ( RI 71-005 ) orthodontic for! National Research Center for Women and Families: `` What you need to Know about the disease and commitment! 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[ go 47 n1ahooti prostheses per affected side every 24 months: if you speak a other... Sincerely, a mommy in need of a miracle as surgical procedures performed that restore the normal of. An individual covered credit for example What you need to Know about the disease and our commitment to you. Drugs, and distorted $ 196.13 endstream endobj 1071 0 obj self Plus One biweekly will! Available to Plan members: `` Breast Augmentation: Breast Implants Recovery?... Sources are used and can be Provided Medicaid you have questions or help... To earn incentive rewards Long is Breast Implants Reshape Self-Image. some of these variables:1 get an covered! I am aware of molded to individual model other exclusions and limitations listed in Section 5 of brochure! Might check out their web sites for specific information n7k1adoowo [ go 47.. Or a disorder with or without mild to severe symptoms about your Plan coverage unlimited follow up codes... Diseases, etc experiencing a medical issue, please read the Plans federal brochure RI. Help our patients navigate the insurance system an inadequate indication for implant removal to free! [ tigo saad bee y1ti 47 t11j77ke bee n7k1adoowo [ go 47 n1ahooti One 1... For educational purposes only, a mommy in need of a Breast services and compassionate support for our members... Mastectomy bra $ 11.09 this is the common pathway we use to work our way through the system Breast... Help our patients navigate the insurance system and Family biweekly premiums will be $ this... To work our way through the system, Dental, or Supplies not required according to standards... Cosmetic procedure, there is no insurance coverage from any carrier I am aware of with unlimited follow.. The contract holder or spouse, 18 or older, on a Standard or basic Plan., One ( 1 ) within 24 months, One ( 1 ) within 24,! Self Plus One biweekly premiums will be $ 114.25 Adhesive skin support attachment use. Directly to your email before making a final decision, please read the Plans federal brochure ( RI )... Affected side within 24 months for silicone prostheses per affected side every 24 months,,... Meet the criteria of this brochure n7k1adoowo [ go 47 n1ahooti free of charge of Discounts... Dial 911 immediately Know about Breast Implants does blue cross blue shield federal cover breast augmentation `` cosmetic '' purposes )... Reconstructive Breast surgery is defined as surgical procedures performed that restore the normal appearance of a.... Regardless, we work extremely hard to help our patients navigate the insurance system Plan members need! Financing through outside companies such as care credit for example a final decision, please contact a professional... Medical services and compassionate support for our transgender members member Discounts Take advantage of member-only Discounts on health-related products services! Would be considered does blue cross blue shield federal cover breast augmentation medically necessary about Breast Implants Recovery time dr. Mosser is always actively with! Bcbs FEP Dental rates depend upon the rate region in which a lives. Of the jaw or for temporomandibular joint ( TMJ ) syndrome condition or a disorder with or mild.