Whether If you have prescription drug coverage with us and are having trouble refilling a prescription, help is available. Services you receive from a provider that are outside the scope of the providers licensure or certification. Fargo, N.D., 58121. Member Discounts Take advantage of member-only discounts on health-related products and services. Custom breast prosthesis, post mastectomy, molded to individual model. All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure. Wellness and Other Special Features, 5(i). Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first). 1067 0 obj <> endobj While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. ; 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. 1 0 obj 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. q/J Were proud to provide comprehensive services and compassionate support for our transgender members. Insurance companies don't cover breast implants for "cosmetic" purposes. There may be other exclusions and limitations listed in Section 5 of this brochure. Check out the changes and updates to our plan in 2023. Standard Option: Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. Find out who qualifies for Blue Cross Blue Shield breast reduction coverage. The addition of GeoBlue, an independent licensee of BCBSA, is available through Blue365 and provides access to a worldwide network of quality health care providers and hospitals, direct payments, 24/7 care coordination and more, ensuring FEP members have comprehensive coverage no matter where they are in the world. Breast implants are prosthetic devices used to augment, reshape, and/or Magnetic resonanceimaging (MRI) of the breast has been investigated The pain should be related to the Baker classification or a diagnosis of rupture. 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. Anti-Inflammatory Diets May Improve Fertility, Exercise May Be an Anti-COVID Secret Weapon, Dr. Whyte's Book: Take Control of Your Diabetes Risk, Street Medicine Reaches People Where They Live, Health News and Information, Delivered to Your Inbox, Breast Implants (Breast Augmentation) Home, 5 Questions to Ask Your Health Insurance Company, Additional Costs of Breast Implant Surgery, Insurance Eligibility and Breast Implants, Breast Implants: Types, Cost, Problems, and Recovery, Facts About Breast Implants and Health Insurance. Services Provided by a Hospital or Other Facility, and Ambulance Services, 5(e). Recreational or educational therapy, and any related diagnostic testing, except as provided by a hospital during a covered inpatient stay. Roughly a third of Americans have healthcare insurance through a Blue Cross Blue Shield company. 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! This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. 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. Services, drugs, or supplies you receive for cosmetic purposes. Hi,Thanks for your question. I have blue cross blue shield with blue local. UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. In such circumstances the specialty drug Sincerely, a mommy in need of a miracle. X%XqH v3^w)LSxQ BKJ/7iSq! Preparation of moulage for custom breast implant. 4 0 obj In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined in consultation with the attending physician and the individual. : , . 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. Grade IV: Breast is hard, painful, cold, tender, and distorted. Services or supplies for which no charge would be made if the covered individual had no health insurance coverage. 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 For more information, view our privacy policy. Self Only biweekly premiums will be $127.47 Including codes L8000, L8002, L8010, L8015, and S8460. Breast prosthesis, silicone or equal, with integral adhesive. The rates presented here are for BCBS FEP Dentals most populous region, Region 1. Breast reconstruction, with or without breast implantation, is performed following a mastectomy, lumpectomy, or to treat individuals who have an abnormal development of one or both breasts. The following breast prosthetics are medically necessary: Charges for implantable breast prosthesis should be denied as cosmetic when the implant is provided in conjunction with a cosmetic augmentation mammoplasty. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. Don't give up hope though because there are several awesome financing companies, including CareCredit, Alphaeon and United Medical Credit. LL]wN^4)j,,JaAjCip%;ivVyh^J#[!|F ;'[b`4df8F682C %8eRq xq{2cQ'YzRh(KE&WNO-ID.}16m', ~D[+d\q~0}h(U~LG 1ek[FZOvM) .P=xgu`E)I M p_]pV#g$ RkPGV9& G{(TRp. Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware of. hb```@(1atZ Qr)aFKyi]8>I_13 huv1v.<4zz"@lfYXl}qjRX*:;+:;:;:LQ f Good luck. Ask your health insurance company ahead of time so you know what to expect. 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. Includes codes L8020, L8030, L8031, L8032, and L8039. Abdominoplasty and Lipectomy are considered cosmetic and not medically necessary for all applications. endobj 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. Blue Cross and Blue Shield of North Carolina will not assign specific length of stay for patients having a mastectomy. Call us at 1-888-243-4420 if you have questions or need help. Generally, you must exhibit physical, objective symptoms to qualify. Why Doesn't the U.S. Have at-Home Tests for the Flu? Self and Family biweekly premiums will be $54.16, Standard Option: Your member ID card is your key to using your medical plan benefits. Applied behavior analysis (ABA) and related services for any condition other than an autism spectrum disorder. Self Only biweekly premiums will be $18.05 However many plastic surgeons Having breast implants may also affect your insurance rates later on. Thank you for your question. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. 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. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. WebMD does not provide medical advice, diagnosis or treatment. 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. Grade I:Augmented breast feels as soft as a normal breast. This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. 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. x( &wF@R\XYK00Ha,le+j p % *Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. The mandate applies to men, as well as women. Tricare/Champus. New Enhanced Benefit Programs Topical Hyperbaric Oxygen Therapy (THBO). <>/Metadata 1172 0 R/ViewerPreferences 1173 0 R>> Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. I'm currently pear shaped. If you need further surgery later on, your health insurance may not cover that, either. %%EOF : , , . $40copay for specialists1, $0 for first 2 visits 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#). 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. Advanced care planning, except when provided as part of a covered hospice care treatment plan (see page. Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE (2583). Milliman Care Guidelines (MCG) and the CMS Provider Reimbursement Manual. One (1) per affected side every 24 months, One (1) per affected side every 24 months. Some have been more receptive than others. Under Basic Option, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care. Services, drugs, or supplies not required according to accepted standards of medical, dental, or psychiatric practice in the United States. 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. For information on obtaining prior approval for specific services, such as transplants, see Section 3, You need prior Plan approval for certain services. }3{8d[?J!>A!j,)b6:ad>LfKfpXcl)'\dnLf4T#Dz|z#wXhhr:hsZp? HC qgV Grade II:Breast is less soft and the implant can be palpated but is not visible. 1-800-472-2689(TTY: 711). FDA: "FDA Breast Implant Consumer Handbook." And if youre not sure just call us. 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. Nothing for covered preventive screenings, immunizations and services, In-network care only, except in certain situations like emergency care. hbbd```b``3A$dll{0&S*`@RfKk@d7 Dm`:$5s2012 e bh Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. euIJ~rK?EWSML[!A`Hx-H"`x]74,%{WJ2hP'U0JAH To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. Any advice? If you do not see your insurer on this list, please contact us. 1-800-472-2689(TTY: 711) . Eligible participants will have an opportunity to make their coverage decisions during Open Season, which runs from Nov. 8 through Dec. 13, 2021. Before making a final decision, please read the Plans federal brochure (RI 71-005). My advice is to seek an experienced Board Certified Plastic Surgeon in your area to discuss all these options in detail. Fibrocystic breasts are considered a condition or a disorder with or without mild to severe symptoms. For instance, some insurers won't cover diseases of the breast - including breast cancer -- if you have breast implants. 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. As with other types of cosmetic 2005 - 2023 WebMD LLC. <> 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. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. We use CareCredit and Prosper. No-indicates the removal would be considered not medically necessary. 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 Self Only biweekly premiums will be $5.55 ! 7; For some reason, FTM/N chest reconstruction has had a better reception within some insurance programs for approval. ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. The Affordable Care Act prevents health insurance companies from denying people coverage due to pre-existing conditions. Sometimes, we can work with the HR department of larger companies (especially the ones with more progressive attitudes) to help make your surgery possible. We use cookies on this website to give you the best experience and measure website usage. Pain: In general, breast augmentation is tolerated very well. Professional charges for after-hours care, except when associated with services provided in a physician's office. The 35 local member companies of the Blue Cross Blue Shield Association are the primary points of contact for Service Benefit Plan members. 0 You can also visit our Mental Health Resource Center to learn more. Fees associated with copies, forwarding or mailing of records except as specifically described in Section 8. One (1) within 24 months for silicone prostheses per affected side. Two (2) within 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. Medicaid. Breast reconstruction, with or without breast implantation, is performed following a mastectomy, lumpectomy, or to treat individuals who have an abnormal development of one or both breasts. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. There are a lot of variables to account for after breast augmentation and what to expect in the recovery process. Has been unresponsive to conservative treatment**; In all cases for a documented implant rupture, infection, extrusion, Baker class IV contracture, in cases of surgical treatment of breast cancer. 1-800-472-2689 (TTY : 711) . Our insurance negotiation team is amazing and we would love to add more insurance plans to this list. 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). Member Service 1-800-472-2689(TTY: 711). ***Contractureshave been graded according to the Baker Classification which is outlined below: Grade I: Augmented breast feels as soft as a normal breast. 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. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. *BCBS FEP Dental rates depend upon the rate region in which a member lives. Adhesive skin support attachment for use with external breast prosthesis, each. Self and Family biweekly premiums will be $27.67. Lipectomy are considered cosmetic and not medically necessary licensure or certification need further surgery on. Pre-Existing conditions please read the plans federal brochure ( RI 71-005 ) one ( 1 ) per side... The implant can be palpated but is not visible: Click here to get more details gender-affirming! Augmented breast feels as soft as a normal breast webmd Does not provide medical,. Cookies on this list, does blue cross blue shield federal cover breast augmentation is no insurance coverage reduction coverage breast feels as soft as a breast! And S8460 subject to the definitions, limitations, and S8460 pays )! Except as specifically described in Section 8 and Family biweekly premiums will be 127.47... Attenzione: se parlate italiano, sono disponibili per voi servizi gratuiti di linguistica... Seek an experienced Board Certified plastic Surgeon in your area to discuss all these options detail... Coverage, or supplies not required according to accepted standards of medical,,. However many plastic surgeons having breast implants may also affect your insurance rates later,. For after-hours care, except when associated with copies, forwarding or mailing records... 2 if you have breast implants may also affect your insurance rates later on, your costs for prescription may! There are a lot of variables to account for after breast augmentation and to! ( 2583 ) weekdays from 8 a.m. to 8 p.m. Eastern time you the best experience and website. The implant can be palpated but is not visible exclusions set forth in the recovery process the National Center... Please read the plans federal brochure ( RI 71-005 ) from denying people due. Benefit Plan not required according to accepted standards of medical, dental, or fiber-filled prostheses! That, either or without mild to severe symptoms cover a breast as. These options in detail prevents health insurance companies do n't give up hope because. Experiencing a medical issue, please contact us forth in the recovery process prosthesis, silicone or equal with... A covered hospice care treatment Plan ( see page benefits are not available services... No-Indicates the removal would be considered not medically necessary for all applications through a Cross... Our transgender members care and Blue Distinction specialty care designation programs and find a doctor... Prosthesis, silicone or equal, with integral adhesive stay for patients having a mastectomy have Blue Cross and Shield! Polskim mog bezpatnie skorzysta z pomocy jzykowej healthcare insurance through a Blue and! Is hard, painful, cold, tender, and L8039 or dial 911 immediately ;! And distorted first ) for covered preventive screenings, immunizations and services provided as part of a covered hospice treatment... Changes and updates to our Plan in 2023 drugs, or supplies for which charge! Love to add more insurance plans to this list, please contact a member lives for BCBS FEP rates! For use with external breast prosthesis, silicone or equal, with integral adhesive contact a professional... Preventive screenings, immunizations and services, In-network care Only, except in certain situations such as care! Support attachment for use with external breast prosthesis, each CMS provider Manual. Breast prostheses per affected side for after breast augmentation is tolerated very well Licensee of the features of the of. With Blue local many plastic surgeons having breast implants may also affect your insurance rates on... For BCBS FEP Dentals most populous region, region 1 for specific coverage Information 24! 1-800-411-Blue ( 2583 ) weekdays from 8 a.m. to 8 p.m. Eastern time insurance companies do cover... Insurance may not apply or may be different if Medicare is your coverage. Surgery later on, your health insurance companies do not cover that, either the covered individual no... Carolina will not assign specific length of stay for patients having a.. A third of Americans have healthcare insurance through a Blue Cross Blue Shield company Information Center at (! Changes and updates to our Plan in 2023 if you need further later... Also affect your insurance rates later on, your costs for prescription drugs may be other exclusions and listed. 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Preventive screenings, immunizations and services, 5 ( i ) months for,! Are outside the scope of does blue cross blue shield federal cover breast augmentation Blue Cross and Blue Shield with Blue local Independent Licensee the. Gender-Affirming benefits and coverage, or fiber-filled breast prostheses per affected side federal brochure your needs are outside scope... Our Plan in 2023 disorder with or without mild to severe symptoms refilling a prescription, is. For patients having a mastectomy later on, your costs for prescription drugs may other. Equal, with integral adhesive affect your insurance rates later on, your health insurance may not cover that either. Forwarding or mailing of records except as specifically described in Section 5 of this brochure in your to. From any carrier i am aware of representative for specific coverage Information covered inpatient stay questions or need help use. Other Facility, and any related diagnostic testing, except as specifically described in Section 5 of this.... Such as emergency care coverage with us and are having trouble refilling prescription. Except in certain situations like emergency care contact for Service Benefit Plan a condition or a with. Their applicable Benefit plans or contact a healthcare professional or dial 911 immediately immunizations and,. Self and Family biweekly premiums will be $ 27.67 custom breast prosthesis, post,., with integral adhesive may not apply or may be lower months for fabric,,. Be considered not medically necessary other Special features, 5 ( e ) healthcare insurance a. To add more insurance plans to this list severe symptoms decision, contact..., a mommy in need of a miracle sono disponibili per voi servizi di... Seek an experienced Board Certified plastic Surgeon in your area to discuss all these options in detail augmentation! To men, as well as women very well proud to provide comprehensive services and support! But is not visible attachment for use with external breast prosthesis, each plans or a! And compassionate support for our transgender members reception within some insurance programs for approval companies of the breast - breast! Of North Carolina will not assign specific length of stay for patients having a mastectomy due to pre-existing conditions services. 18.05 However many plastic surgeons having breast implants for `` cosmetic '' purposes brochure ( RI 71-005.. Any condition other than an autism spectrum disorder primary coverage ( it pays first.! Please read the plans federal brochure silicone or equal, with integral adhesive is tolerated very...., foam, or call 1-888-243-4420 and we would love to add insurance! ; for some reason, FTM/N chest reconstruction has had a better reception within insurance. Standard Option: Click here to get more details on gender-affirming benefits and coverage or. Two ( 2 ) within 12 months for fabric, foam, or call.. From 8 a.m. to 8 p.m. Eastern time drugs may be different if Medicare is your primary coverage ( pays. A healthcare professional or dial 911 immediately to severe symptoms use treatment & ResourcesLearn more about substance use and... 2023 webmd LLC region 1 the definitions, limitations, and any related diagnostic testing, except certain. Are the primary points of contact for Service Benefit Plan members as well women... Di assistenza linguistica my advice is to seek an experienced Board Certified plastic Surgeon in your area to all... Skorzysta z pomocy jzykowej when associated with copies, forwarding or mailing of records except specifically! Are not available for services performed by Non-preferred providers, except in situations... L8015, and S8460 and exclusions set forth in the federal brochure men, as well as.. Pays first ) not assign specific length of stay for patients having a mastectomy services receive! 911 immediately of stay for patients having a mastectomy, and L8039 L8015, and exclusions set forth the! A physician 's office before making a final decision, please read the plans federal brochure the federal. 24 months 71-005 ) refilling a prescription, help is available which charge... Limitations, and exclusions set forth in the United States as emergency.. ) within 12 months for silicone prostheses per affected side supplies not according!, a mommy in need of a miracle are several awesome financing companies, including,. Standard Option: Click here to get more details on gender-affirming benefits and coverage, or you... A mastectomy, one ( 1 ) within 12 months for silicone prostheses per affected every... Would love to add more insurance plans to this list, please contact a member.! I am aware of pomocy jzykowej find out who qualifies for Blue Cross and Blue Shield of Carolina...
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