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Mastectomy is the removal of all or part of a breast and is typically performed as a treatment for cancer, or sometimes for the treatment of benign disease. Fibrocystic breasts are considered a condition or a disorder with or without mild to severe symptoms. x]s6=3x;Lin4{ #Hs A $Yr"Sv]'66M1eyES-|KY]x~sg*_;69"vsY?Y3?{w5L?&`~^/I?YdPdZ8b\ Abdominoplasty and Lipectomy are considered cosmetic and not medically necessary for all applications. Is there a rule of thumb or tips for choosing breast augmentation sizes? Self Plus One biweekly premiums will be $7.11 Two (2) every 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. Although cosmetic procedures are never covered by insurance, certain procedures related to your surgery may be For some reason, FTM/N chest reconstruction has had a better reception within some insurance programs for approval. 'lC >)a}QO=_Q 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. 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). Self Only biweekly premiums will be $127.47 %PDF-1.5 % You might check out their web sites for specific information. 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. In most practices, including ours, financing programs are available. Self Plus One biweekly premiums will be $289.61 endstream endobj startxref 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. Services or supplies for which no charge would be made if the covered individual had no health insurance coverage. Our insurance negotiation team is amazing and we would love to add more insurance plans to this list. Breast augmentation is considered a cosmetic procedure, thus no insurance coverage is available. Most physicians work with companies that finance c Most surgeons do offer financing through outside companies such as Care credit for example. 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) , 1-800-472-2689(: 711). Only in those individuals who had originally undergone breast implantation for reconstructive purposes. 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. As with other types of cosmetic ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. DrMaz. You will have no success getting breast implants surgery covered by any insurance plan. Most physicians will offer financing through an outside fin Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Select Blue Cross Blue Shield Globalor GeoBlue if you have international coverage and need to find care outside the United States. Enhanced Dental and Vision Benefits for Children 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 BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. Preparation of moulage for custom breast implant. section or contact us directly! Includes codes L8030, L8031, L8032, L8035, and L8039. Hi,Thanks for your question. (ID Card) 1-800-472-2689(TTY: 711). Complications of breast implants are common and may require removal of the implant. Additional information about 2022 benefits is available online or by calling the National Information Center. Check our F.A.Q. WebSection V-Surgical Management of Breast Implants. Reconstructive breast surgery is defined as those surgical procedures performed that are designed to restore the normal appearance of a breast. Any advice? Fees associated with copies, forwarding or mailing of records except as specifically described in Section 8. All changes will take effect Jan. 1, 2022. 1-800-472-2689 (TTY : 711) . Services, drugs, or supplies you receive while you are not enrolled in this Plan. This is all new to me & I've wanted implants since my teenage years. (Use the measurement key below) PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. 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. Naley zadzwoni do Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689(TTY: 711). How Long is Breast Implants Recovery Time? Some insurance companies consider breast augmentation surgery a "pre-existing condition," and some women who have had breast implants have found that they have problems getting health care coverage. Insurance usually will not cover breast enlargement surgery. ID 1-800-472-2689TTY: 711. Blue Cross and Blue Shield of North Carolina will not assign specific length of stay for patients having a mastectomy. Travel expenses except as specifically provided for covered transplants performed in a Blue Distinction Center for Transplant (see page. NSM not meeting the criteria as indicated in this policy is considered not medically necessary. Reduction mammoplasty. *Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. hb```,RQ WebReview the links below for information relevant to your coverage. Appelez le Service adhrents au numro indiqu sur votre carte dassur appel1-800-472-2689 (TTY : 711). You will have no success getting breast implants surgery covered by any insurance plan. This information does not apply to members who have Medicaid or Medicare plans. 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. Mayo Clinic: "Breast Augmentation: Breast Implants Reshape Self-Image." 500 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. **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. Includes codes L8020, L8030, L8031, L8032, and L8039. 1-800-472-2689(TTY: 711). 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. WebBreast implants complications are common and may require removal of the implant. ID 1-800-472-2689TTY 711). Includes codes L8000, L8001, L8002, L8015, and S8460. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. euIJ~rK?EWSML[!A`Hx-H"`x]74,%{WJ2hP'U0JAH Services Provided by a Hospital or Other Facility, and Ambulance Services, 5(e). 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. Medicare Advantage members, please call 877-817-0493 all other members please call, 877-817-0477. Quantity Level Limits For Breast Prosthetics. FDA: "FDA Breast Implant Consumer Handbook." 0 Please call 1-888-243-4420 for more information. 1170 0 obj <>/Filter/FlateDecode/ID[]/Index[1152 46]/Info 1151 0 R/Length 91/Prev 123788/Root 1153 0 R/Size 1198/Type/XRef/W[1 2 1]>>stream This is the common pathway we use to work our way through the system. Self and Family biweekly premiums will be $16.64, Standard Option: Under Basic Option, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care. Recreational or educational therapy, and any related diagnostic testing, except as provided by a hospital during a covered inpatient stay. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. Before making a final decision, please read the Plans federal brochure (RI 71-005). Membership or concierge service fees charged by a healthcare provider. Web1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. This includes all stages of reconstruction of the breast on which the mastectomy has been performed, surgery and reconstruction of the other breast to produce a symmetrical appearance and prostheses and treatment of physical complications of all stages of the mastectomy including lymphedemas. All rights reserved. 4510 13th Ave. S. WASHINGTON, Sep. 30, 2021 Today the Blue Cross and Blue Shield (BCBS) Government-wide Service Benefit Plan, also known as the Federal Employee Fargo, N.D., 58121. Augmentation mammoplasty. Grade I:Augmented breast feels as soft as a normal breast. : , , . Roughly a third of Americans have healthcare insurance through a Blue Cross Blue Shield company. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. One (1) every 24 months for silicone prostheses per affected side. Services, Drugs, and Supplies Provided Overseas, Non-FEHB Benefits Available to Plan Members. Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. Call 1-888-243-4420, and please let us know your preferred name and your pronouns. stream Medicare. }3{8d[?J!>A!j,)b6:ad>LfKfpXcl)'\dnLf4T#Dz|z#wXhhr:hsZp? 2 0 obj Sometimes, we can work with the HR department of larger companies (especially the ones with more progressive attitudes) to help make your surgery possible. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. 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). Custom breast prosthesis, post mastectomy, molded to individual model. HC qgV EUmsCd}]'`d w! M 4 0 obj I'm currently pear shaped. This mandate further defines coverage for the following: Mastectomy may be considered medically necessary for the symptoms and diagnosis, or treatment of the member's condition, illness, or injury. Stay in-network for care. There are lots of implant options out there. The researchers analyzed coverage status from 57 US insurance companies, only one of which had no relevant policy on these procedures. 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. endobj The rates presented here are for BCBS FEP Dentals most populous region, Region 1. One (1) within 24 months for silicone prostheses per affected side. Cancer does not have to be the reason for the mastectomy. Thank you for your question. Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). 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