Self Plus One biweekly premiums will be $18.44 New Enhanced Benefit Programs Blepharoplasty/Brow reduction/brow lift (removal of redundant skin of the upper and/or lower eyelids and protruding periorbital fat) III. Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined in consultation with the attending physician and the individual. Self and Family biweekly premiums will be $16.64, Standard Option: Grade II:Breast is less soft and the implant can be palpated but is not visible. Self Only biweekly premiums will be $3.56 Determining the Blue Cross and Blue Shield Association National policy 7.01.22 Reconstructive Breast Surgery/Management of Breast Implants. WebAdditional Costs of Breast Implant Surgery. Check our F.A.Q. 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. ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including For instance, some insurers won't cover diseases of the breast - including breast cancer -- if you have breast implants. Calf implants IV. : , , . Tricare/Champus. 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 Grade IV: Breast is hard, painful, cold, tender, and distorted. At present, we have gotten successful insurance approval for FTM/N top surgery from the following insurers: Anthem BC <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. Good luck. The Women's Health and Cancer Rights Act of 1998 (WHCRA) is federal legislation that provides that any individual, with insurance coverage who is receiving benefits in connection with a mastectomy covered by their benefit plan (whether or not for cancer) who elects breast reconstruction, must receive coverage for the reconstructive services as provided by WHCRA. Includes codes L8020, L8030, L8031, L8032, and L8039. Services or supplies for which no charge would be made if the covered individual had no health insurance coverage. 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. Self Only biweekly premiums will be $127.47 Milliman Care Guidelines (MCG) and the CMS Provider Reimbursement Manual. Implantable breast prosthesis, silicone or equal. This document addresses gender affirming surgery (also known as sex affirmation surgery, gender or sex reassignment surgery, gender or sex confirmation <> Meet with a board certified plastic surgeon to discuss your goals, get a quote and find out what financing options they offer.Best of Luck! 3You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. Will having breast implants affect my coverage if I later develop, Will any of the diagnostic tests that I may need after getting breast implants, such as MRIs or extra. 2020 Blue Cross Blue Shield Association. Includes codes L8000, L8001, L8002, L8010, and S8460. Before you get breast implants, ask your insurance company these five questions: Get the answers in writing and check back with your insurance company every couple of years, since it may change its policy. Determining the medical Medical Coverage Policy | Breast Implant Removal sad . **Conservative treatment for fibrocystic breasts consists of, but is not limited to: support bras, avoiding trauma, avoiding caffeine, medication for pain, anti-inflammatory drugs, hormonal manipulation, use of vitamin E, use of diuretics, and salt restrictions. American Society for Aesthetic Plastic Surgery. Augmentation mammoplasty. Transverse rectus abdominis myocutaneous flap (TRAM), latissimus dorsi flap or free flap. hbbd```b``3A$dll{0&S*`@RfKk@d7 Dm`:$5s2012 e bh Ask your health insurance company ahead of time so you know what to expect. X%XqH v3^w)LSxQ BKJ/7iSq! Topical Hyperbaric Oxygen Therapy (THBO). 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. It is slightly more challenging to get coverage for MTF/N breast augmentation procedures, but it is certainly still achievable. Cancer does not have to be the reason for the mastectomy. endstream endobj 1153 0 obj <. Self Plus One biweekly premiums will be $196.13 2023 Blue Cross Blue Shield Association. Self and Family biweekly premiums will be $125.67 Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag1-800-472-2689(TTY: 711). The mandate applies to men, as well as women. There may be other exclusions and limitations listed in Section 5 of this brochure. . Services or supplies we are prohibited from covering under the Federal Law. Wellness and Other Special Features, 5(i). *Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. Mental Health and Substance Use Disorder Benefits, 5(h). To access your member services, please visit your BCBS company. UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. 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. National Research Center for Women and Families: "What You Need to Know about Breast Implants." **Painas an isolated symptom is an inadequate indication for implant removal. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. 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. 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. 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). section or contact us directly! This is the common pathway we use to work our way through the system. All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure. 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. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689(TTY: 711). The rates presented here are for BCBS FEP Dentals most populous region, Region 1. 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. Call us at 1-888-243-4420 if you have questions or need help. Self Only biweekly premiums will be $5.55 2 0 obj Abdominoplasty and Lipectomy are considered cosmetic and not medically necessary for all applications. Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele1-800-472-2689 TTY: 711). Updated Dental and Vision Digital Sites Member Service 1-800-472-2689(TTY: 711). Blue Cross and Blue Shield of North Carolina will not assign specific length of stay for patients having a mastectomy. Services you receive from a provider that are outside the scope of the providers licensure or certification. In those individuals who had originally undergone breast implantation for reconstructive purposes. With PPO insurance plans that cover transgender surgery, we are usually able to get a portion (if not all) of the surgery covered. endstream endobj startxref 500 Greater than or equal to 13 months post mastectomy. endobj 3 0 obj Sincerely, a mommy in need of a miracle. If you need a breast reduction for medical or cosmetic reasons, you may be %PDF-1.5 % For information on obtaining prior approval for specific services, such as transplants, see Section 3, You need prior Plan approval for certain services. ? All rights reserved. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. Less than or equal to 12 months post mastectomy. Each insurance company such as Blue Cross Blue Shield has its own standards on what qualifies a patient for insurance coverage of a breast reduction. %vH>jJ(BS+4t|!vLSM z7&^\&gN;ObtGn=M&qbn' IL\] #5!qgu02>/qdV&JUNeHyYYQD-LKR(=#s!R{@*^Gg&lrGAegn[R-{.{/om?DiQiH9e1A Services, drugs, or supplies you receive without charge while in active military service. This is a fixed cost price with unlimited follow up. The Affordable Care Act prevents health insurance companies from denying people coverage due to pre-existing conditions. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. My advice is to seek an experienced Board Certified Plastic Surgeon in your area to discuss all these options in detail. 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. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Mastopexy. Self and Family biweekly premiums will be $10.67, Blue Cross Blue Shield FEP Dental Premiums in 2022*, High Option: I'm currently pear shaped. Web1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. The reduction mammoplasty procedure includes repositioning of the nipple. The benefits of coconut, argan, tea tree and more. With enhanced benefits in all products in 2022, FEP continues its mission to provide unparalleled products and services to our members and their families.. (or any amounts you desire). Last review: July 2003. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral. 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). Self Only biweekly premiums will be $18.05 Standard Option: Sometimes, we can work with the HR department of larger companies (especially the ones with more progressive attitudes) to help make your surgery possible. PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. -L Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. *dlVU! Personal comfort items such as beauty and barber services, radio, television, or phone. You might check out their web sites for specific information. Furniture (other than medically necessary durable medical equipment) such as commercial beds, mattresses, chairs. Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE (2583). We use CareCredit and Prosper. It will, though, cover breast implants for women who have had mastectomies due to breast cancer. x]s6=3x;Lin4{ #Hs A $Yr"Sv]'66M1eyES-|KY]x~sg*_;69"vsY?Y3?{w5L?&`~^/I?YdPdZ8b\ Orthodontic care for malposition of the bones of the jaw or for temporomandibular joint (TMJ) syndrome. Fifty-three of the 57 insurance companies provided coverage for gender-affirming top surgery, after preauthorization. We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. : -, . WebScreening uses include screening for breast cancer in patients who are at high genetic risk for breast cancer. 1-800-472-2689 (TTY : 711) . 0 Before making a final decision, please read the Plans federal brochure (RI 71-005). Services, drugs, or supplies not required according to accepted standards of medical, dental, or psychiatric practice in the United States. Self Plus One biweekly premiums will be $11.09 Were proud to provide comprehensive services and compassionate support for our transgender members. 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. 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. hb```,RQ Call 1-800-200-4255(TTY: 711). All changes will take effect Jan. 1, 2022. ART-20203231. 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