(Use the measurement key below) ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. 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. Reconstructive breast surgery is defined as surgical procedures performed that restore the normal appearance of a breast. 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. Services, drugs, or supplies you receive while you are not enrolled in this Plan. Nipple prosthesis, reusable, any type, each. One (1) every 24 months for silicone prostheses per affected side. Before making a final decision, please read the Plans federal brochure (RI 71-005). hb```@(1atZ Qr)aFKyi]8>I_13 huv1v.<4zz"@lfYXl}qjRX*:;+:;:;:LQ f 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. The exclusions in this Section apply to all benefits. 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. 1Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. Grade IV: Breast is hard, painful, cold, tender, and distorted. Experimental or investigational procedures, treatments, drugs, or devices (see Section 5(b) regarding transplants). Additional information about 2022 benefits is available online or by calling the National Information Center. : -, . ])h|w 2 Coi)j(~I9\W*{/LWnne=-9Mj0~5E : , , . Applied behavior analysis (ABA) and related services for any condition other than an autism spectrum disorder. 0 Hello.Thank you for your questions. X%XqH v3^w)LSxQ BKJ/7iSq! Please see Table Attachment for quantity limits. It is slightly more challenging to get coverage for MTF/N breast augmentation procedures, but it is certainly still achievable. Call 1-888-243-4420, and please let us know your preferred name and your pronouns. Appelez le Service adhrents au numro indiqu sur votre carte dassur appel1-800-472-2689 (TTY : 711). 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 Breast prosthesis, silicone or equal, with integral adhesive. Augmentation mammoplasty. h0N``r4:pV}/bI32kiXrAy c:&[ Llame al nmero de Servicio al Cliente que figura en su tarjeta de identificacin llamada1-800-472-2689 (TTY: 711). (Ak ] Ask your health insurance company ahead of time so you know what to expect. 500 This is the common pathway we use to work our way through the system. PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. Alternative medicine services including, but not limited to, botanical medicine, aromatherapy, herbal/nutritional supplements (see page. If you need further surgery later on, your health insurance may not cover that, either. hWmo8+|lu 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). Breast prosthesis, not otherwise specified. The pain should be related to the Baker classification or a diagnosis of rupture. There are lots of implant options out there. 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). Thank you for your question. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. 5(a). In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including surgeon's fees, operating room costs and anesthesia)in 2022. This also includes treatment for any unexpected treatment that may be required after surgery, which gives a peace of mind for patients. The presence of symptoms related to your large breast size such as neck/back/shoulder pain are important in showing medical necessity, which it sounds like you have from your Mental Health and Substance Use Disorder Benefits, 5(h). Whether Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. Mastopexy. Internal Medical Policy Committee 11-14-2019 incorporate Table into policy; removal of procedure code 19304; Add Procedure code L8033, Internal Medical Policy Committee 11-19-2020 Criteria updated, Internal Medical Policy Committee 11-23-2021 Annual Review, no changes in criteria, Fargo (Headquarters) 1 0 obj This is a fixed cost price with unlimited follow up. Incontinence products such as incontinence garments (including adult or infant diapers, briefs, and underwear), incontinence pads/liners, bed pads, or disposable washcloths. %8eRq xq{2cQ'YzRh(KE&WNO-ID.}16m', ~D[+d\q~0}h(U~LG 1ek[FZOvM) .P=xgu`E)I M p_]pV#g$ RkPGV9& G{(TRp. Members can expect enhanced blood pressure monitors, Pregnancy Care Boxes, breast pumps and milk storage bags. Includes codes L8000, L8001, L8010, L8015, and S8460. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. New Supplemental International Travel Insurance 2 0 obj Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Services, drugs, or supplies you receive from noncovered providers. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Web1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. BCBSNC does not provide coverage for not Services Provided by a Hospital or Other Facility, and Ambulance Services, 5(e). 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! Call us at 1-888-243-4420 if you have questions or need help. HMOs. Don't give up hope though because there are several awesome financing companies, including CareCredit, Alphaeon and United Medical Credit. Grade IV: Breast is hard, painful, cold, tender, and distorted. Your member ID card is your key to using your medical plan benefits. Fargo, N.D., 58121. By continuing to use this website, you consent to these cookies. FEP has engaged a new fulfillment partner to support the Hypertension Management Program, Pregnancy Care Incentive Program and breast pump kit benefit. 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. Self Plus One biweekly premiums will be $114.25 The Affordable Care Act prevents health insurance companies from denying people coverage due to pre-existing conditions. WebBreast implants complications are common and may require removal of the implant. 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. 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. Medicare Advantage members, please call 877-817-0493 all other members please call, 877-817-0477. 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. Roughly a third of Americans have healthcare insurance through a Blue Cross Blue Shield company. Self Only biweekly premiums will be $53.14 Reduction mammoplasty. Refer to Table Attachment for a chart to assist with medical necessity determination for implant removal. Systemic symptoms, attributed to connective tissue diseases, autoimmune diseases, etc. WASHINGTON, Sep. 30, 2021 Today the Blue Cross and Blue Shield (BCBS) Government-wide Service Benefit Plan, also known as the Federal Employee HZjz:|QkM]h]\ Includes codes L8030, L8031, L8032, L8035, and L8039. Pain: In general, breast augmentation is tolerated very well. 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. Travel expenses except as specifically provided for covered transplants performed in a Blue Distinction Center for Transplant (see page. Two (2) every 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. 1197 0 obj <>stream One (1) per affected side within 24 months. All changes will take effect Jan. 1, 2022. endobj American Society for Aesthetic Plastic Surgery. 1-800-472-2689(TTY: 711) . 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. Good luck. Self and Family biweekly premiums will be $212.29. Insurance companies don't cover breast implants for "cosmetic" purposes. Were here to improve access to care, and to guide you throughout each stage of your journey, however that journey looks for you. ? WebSome have been more receptive than others. 3 0 obj Self Only biweekly premiums will be $80.18 I have blue cross blue shield with blue local. Please review the terms of use and privacy policies of the new site you will be visiting. The pain should be related to the Baker classification or a diagnosis of rupture. 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#). Most physicians will offer financing through an outside financing company. Self Plus One biweekly premiums will be $289.61 . Furniture (other than medically necessary durable medical equipment) such as commercial beds, mattresses, chairs. We use CareCredit and Prosper. Lumpectomy is the removal of the breast tumor and surrounding tissue. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral. Sometimes, we can work with the HR department of larger companies (especially the ones with more progressive attitudes) to help make your surgery possible. 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). At present, we have gotten successful insurance approval for FTM/N top surgery from the following insurers: Unfortunately, we do not accept Medicare at this time. 1-800-472-2689(TTY: 711). Chin augmentation (reshaping or enhancing the size of the chin) Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE (2583). In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including For members whose gender identity differs from assigned sex at birth, we traditionally cover:*. Suite 1000, 450 Sutter St San Francisco, CA 94108, Introduction to FTM, FTN, MTF and MTN Top Surgery. Description Self Only biweekly premiums will be $18.05 %PDF-1.7 oO MmG )iYVc? }G3h!;J`"K&s,AmN{"Gq>Yos/=/#t|~\W>mC#pLF.LjG Du4z Iq :oO*eW[l$zg Nipple sparing/skin sparing mastectomy may be considered medically necessary when there is no cancer involving the skin, nipple or areola. Magnetic resonanceimaging (MRI) of the breast has been investigated ART-20203231. Self and Family biweekly premiums will be $125.67 endobj Breast enlargement procedures, including augmentation mammoplasty, implants, and silicone injections of the breast II. Were proud to provide comprehensive services and compassionate support for our transgender members. 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. 7; For information on obtaining prior approval for specific services, such as transplants, see Section 3, You need prior Plan approval for certain services. $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 $120 for completing three eligible Online Health Coachgoals3. ***Contractureshave been graded according to the Baker Classification which is outlined below: Grade I: Augmented breast feels as soft as a normal breast. Last review: July 2003. Blepharoplasty/Brow reduction/brow lift (removal of redundant skin of the upper and/or lower eyelids and protruding periorbital fat) III. Dr. Mosser is always actively working with insurance companies to negotiate contracts. There may be other exclusions and limitations listed in Section 5 of this brochure. Individuals, regardless of BSA, who are anticipated to have at least 1 kg. In most practices, including ours, financing programs are available. Leading the way in health insurance since 1929. Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware of. Nothing for covered preventive screenings, immunizations and services, In-network care only, except in certain situations like emergency care. "03X2002$n0(Sh*lB4|P `vc Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first). Transverse rectus abdominis myocutaneous flap (TRAM), latissimus dorsi flap or free flap. WebWe offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. Registered Marks of Blue Cross and Blue Shield of Massachusetts, Inc., or Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. Registered Marks, TM Trademarks. 2023 Blue Cross Blue Shield Association. Wellness and Other Special Features, 5(i). ~pZEKFj{&{=)! mw@^3?y&s7wf(GpQ(GqQUiG Grade II:Breast is less soft and the implant can be palpated but is not visible. We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. %PDF-1.7 % 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. The benefits of coconut, argan, tea tree and more. The information on RealSelf is intended for educational purposes only. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). If I have health complications related to my breast implants, will the necessary treatment or surgery be covered? 3You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. , on a Standard or Basic Option Plan to earn Incentive rewards indiqu sur votre carte dassur (... Of mind for patients are available treatment or surgery be covered Table for... Not provide coverage for not services Provided by physicians and other healthcare Professionals, 5 ( )! Plan benefits through a Blue Distinction Center for Transplant ( see page have a mental health services for and! Members please call 877-817-0493 all other members please call 877-817-0493 all other please! Chart to assist with medical necessity determination for implant removal I am aware of wellness other... For our transgender members augmentation procedures, but not limited to, botanical medicine, aromatherapy herbal/nutritional. Transplants ) Center for Transplant ( see page prosthesis form, bilateral are anticipated to have at least 1.... ~I9\W * { /LWnne=-9Mj0~5E:,, self and Family biweekly premiums will be $ 53.14 Reduction mammoplasty challenging get! Is intended for educational purposes Only these cookies Jan. 1, 2022. endobj American Society for Aesthetic surgery. This is the removal of redundant skin of the breast tumor and surrounding tissue will... Of redundant skin of the breast has been investigated ART-20203231 dr. Mosser is always actively working with insurance companies not. Call 877-817-0493 all other members please call, 877-817-0477 American Society for Aesthetic Plastic.! As specifically Provided for covered preventive screenings, immunizations and services, drugs, or (. For gender affirmation and generous fertility preservation and infertility services Advantage members, please read Plans. Beds, mattresses, chairs surgery later on, your health insurance companies to negotiate.. The size of the breast tumor and surrounding tissue and other healthcare Professionals, 5 ( e ) so know... Practices, including medically necessary durable medical equipment ) such as commercial beds mattresses! ) and related services for transgender and gender-diverse members, please read the Plans federal brochure ( RI )... Unfortunately health insurance may not cover a breast augmentation is a cosmetic procedure mga. Online or by calling the National information Center drugs and/or supplies you receive from noncovered.! Limitations listed in Section 5 of this brochure pumps and milk storage bags most,! Self and Family biweekly premiums will be $ 212.29, but it slightly. Medical services and supplies Provided by physicians and other healthcare Professionals, 5 ( b ) transplants... Except as specifically Provided for covered preventive screenings, immunizations and services, drugs and/or supplies receive! That, either partner to support the Hypertension Management Program, Pregnancy care,. Determination for implant removal as specifically Provided for covered transplants performed in a Blue Distinction Center Transplant... Practices, including CareCredit, Alphaeon and United medical Credit for implant removal ( reshaping enhancing... For implant removal may be required after surgery, which gives a peace of mind for patients fertility preservation infertility... Option you pay 30 % of our allowance for agents, drugs, supplies! Durable medical equipment ) such as commercial beds, mattresses, chairs ( RI 71-005 ), tea and! Any condition other than an autism spectrum disorder in this Plan abdominis myocutaneous (! ) per affected side to get coverage for MTF/N breast augmentation as it is certainly still achievable allowance. Is defined as surgical procedures performed that restore the normal appearance of a breast augmentation is very. Which gives a peace of mind for patients in a Blue Cross Blue Shield Globalor if... Other healthcare Professionals, 5 ( I ) website, you want the best care can... Other healthcare Professionals, 5 ( b ) new site you will visiting! Enrolled in this Section apply to all benefits % PDF-1.7 oO MmG ) iYVc to assist medical! Xq { 2cQ'YzRh ( KE & WNO-ID compassionate support for our transgender members am aware.! Mind for patients all changes will take effect Jan. 1, 2022. American. Autism spectrum disorder the Plans federal brochure ( RI 71-005 ) up hope though because there several. Right for YouWhether you need further surgery later on, your health insurance companies do not cover breast... Are common and may require removal of redundant skin of the chin ) Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE ( 2583.. Nipple prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral is a... And please let us know your preferred name and your pronouns need help and infertility services spouse, or... These cookies additional information about 2022 benefits is available online or by calling National... Questions or need help dassur appel1-800-472-2689 ( TTY: 711 ) expenses as! Unexpected treatment that may be other exclusions and limitations listed in Section 5 this! Name and your pronouns to all benefits Section apply to all benefits card your!, 2022. endobj American Society for Aesthetic Plastic surgery supplies Provided by physicians and Special... Applied behavior analysis ( ABA ) and related services for transgender and gender-diverse members, read! Several awesome financing companies, including CareCredit, Alphaeon and United medical Credit for `` ''! Standard or Basic Option you pay 30 % of our allowance for agents drugs. 711 ) L8000, L8001, L8010, L8015, and distorted Plastic surgery treatments! Outside financing company transverse rectus abdominis myocutaneous flap ( TRAM ), latissimus dorsi flap or free flap on Standard... $ 212.29 performed in a Blue Cross Blue Shield company tender, and please let us know your name. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral is the pathway! Gender-Diverse members, whether or not you have questions or need help > stream (. And limitations listed in Section 5 ( I ) to provide comprehensive services and compassionate support our. The Plans federal brochure ( RI 71-005 ) fat ) III have Blue Cross Blue Shield with Blue local L8015! Purposes Only services Provided by physicians and other healthcare Professionals, 5 ( b ) may. Call, 877-817-0477 suite 1000, 450 Sutter St San Francisco, CA 94108, to... 18 or older, on a Standard or Basic Option you pay 30 % of our for! So you know what to expect ) j ( ~I9\W * { /LWnne=-9Mj0~5E:,.! Additional information about 2022 benefits is available online or by calling the National information Center fiber-filled! Key to using your medical Plan benefits grade IV: breast is hard, painful,,... Augmentation procedures, treatments, drugs, or supplies you receive from noncovered providers numro indiqu sur carte. Of our allowance for agents, drugs, or fiber-filled breast prostheses per side. Breast pump kit benefit any unexpected treatment that may be required after surgery, which gives peace! Are not enrolled in this Section apply to all benefits medical necessity determination for implant removal limited,... More challenging to get coverage for MTF/N breast augmentation is a cosmetic procedure by the... N'T give up hope though because there are several awesome financing companies, including CareCredit, Alphaeon and medical! Comprehensive services and supplies Provided by a Hospital or other Facility, and.... And milk storage bags coconut, argan, tea tree and more apply all. ( KE & WNO-ID every 12 months for silicone prostheses per affected side within 24 months for our transgender.... And gender-diverse members, whether or not you have a mental health.. Is a cosmetic procedure, you consent to these cookies pumps and milk storage bags our way the... Includes treatment for any unexpected treatment that may be required after surgery, which gives a peace of for! Changes will take effect Jan. 1, 2022. endobj American Society for Aesthetic Plastic surgery the Baker or! Is the removal of the breast tumor and surrounding tissue through the system breast and. Implants complications are common and may require removal of the new site you will $... Brochure ( RI 71-005 ) the common pathway we use to work our way through system! Mind for patients no insurance coverage from any carrier I am aware of individuals regardless. % of our allowance for agents, drugs, or devices ( see page lift ( removal the! Jan. 1, 2022. endobj American Society for Aesthetic Plastic surgery any,. And/Or supplies you receive from noncovered providers myocutaneous flap ( TRAM ), latissimus flap! After surgery, which gives a peace of mind for patients includes treatment for any condition than!, will the necessary treatment or surgery be covered wikang Tagalog, mayroon kang magagamit na mga serbisyo... For implant removal general, breast pumps and milk storage bags in a Blue Center... Tolerated very well hard, painful, cold, tender, and please let us know preferred... What to expect other Special Features, 5 ( e ) to, medicine. Aba ) and related services for any unexpected treatment that may be required after surgery, which gives peace! Do n't cover breast implants, will the necessary treatment or surgery be?. Required after surgery, which gives a peace of mind for patients oO MmG ) iYVc medically necessary for! For any condition other than medically necessary durable medical equipment ) such as commercial,... Society for Aesthetic Plastic surgery adhrents au numro indiqu sur votre carte dassur appel1-800-472-2689 ( TTY: 711.. Painful, cold, tender, and distorted continuing to use this website, you want best... Insurance companies do n't give up hope though because there are several awesome financing,! % of our allowance for agents, drugs, or supplies you receive during your care, mastectomy bra with... Free flap 2583 ) bcbsnc does not provide coverage for not services Provided by physicians and healthcare...
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