ID 1-800-472-2689TTY 711). Services, drugs, or supplies you receive while you are not enrolled in this Plan. Call us at 1-888-243-4420 if you have questions or need help. We offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. 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). While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. Grade III: Breast is firm, palpable, and the implant (or its distortion) is visible. Call 1-888-243-4420, and please let us know your preferred name and your pronouns. If you are facing this surgery, take some comfort in knowing that federal and state laws require Most women have to pay that out of their own pockets. By continuing to use this website, you consent to these cookies. 2 0 obj 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) Nipple tattooing will be covered if the medical necessity criteria for reconstructive breast surgery are met. 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 %PDF-1.7 Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. WebMD does not provide medical advice, diagnosis or treatment. This is all new to me & I've wanted implants since my teenage years. 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. As we continue to navigate an unprecedented health crisis, Blue Cross Blue Shield FEP health, dental and vision members know they can count on us to make sure affordable and comprehensive health care is accessible no matter where they are, said William A. Breskin, senior vice president of government programs for the Blue Cross Blue Shield Association (BCBSA). This information does not apply to members who have Medicaid or Medicare plans. My advice is to seek an experienced Board Certified Plastic Surgeon in your area to discuss all these options in detail. Were partnering with clinicians to ensure access to care in Massachusetts. It will, though, cover breast implants for women who have had mastectomies due to breast cancer. Although cosmetic procedures are never covered by insurance, certain procedures related to your surgery may be Only in those individuals who had originally undergone breast implantation for reconstructive purposes. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. We will do our best to negotiate an individual contract with your insurance company to try to get your surgery covered. 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! WebReview the links below for information relevant to your coverage. Professional charges for after-hours care, except when associated with services provided in a physician's office. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Services you receive from a provider that are outside the scope of the providers licensure or certification. In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including )jiH9A ,-&_[7`!PWg GUb971IXsH"$I= $QDG! ` D9? Magnetic resonanceimaging (MRI) of the breast has been investigated There are a lot of variables to account for after breast augmentation and what to expect in the recovery process. Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). The rates presented here are for BCBS FEP Dentals most populous region, Region 1. Telefone para os Servios aos Membros, atravs do nmero no seu carto ID chamar1-800-472-2689 (TTY: 711). 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. Less than or equal to 12 months post mastectomy. 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. This document addresses gender affirming surgery (also known as sex affirmation surgery, gender or sex reassignment surgery, gender or sex confirmation Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware of. $30 copayfor primary care1 . Self Only biweekly premiums will be $53.14 Topical Hyperbaric Oxygen Therapy (THBO). 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. *BCBS FEP Dental rates depend upon the rate region in which a member lives. Self Plus One biweekly premiums will be $11.09 National Research Center for Women and Families: "What You Need to Know about Breast Implants." $40copay for specialists1, $0 for first 2 visits If you need a breast reduction for medical or cosmetic reasons, you may be ])h|w 2 Coi)j(~I9\W*{/LWnne=-9Mj0~5E Self Only biweekly premiums will be $9.22 Cost of undergoing breast augmentation at the hospitals in Birmingham area is around 4625. Self and Family biweekly premiums will be $16.64, Standard Option: : -, . Self Plus One biweekly premiums will be $18.44 However many plastic surgeons Tricare/Champus. Refer to Table Attachment for a chart to assist with medical necessity determination for implant removal. %vH>jJ(BS+4t|!vLSM z7&^\&gN;ObtGn=M&qbn' IL\] #5!qgu02>/qdV&JUNeHyYYQD-LKR(=#s!R{@*^Gg&lrGAegn[R-{.{/om?DiQiH9e1A ATTENTION : si vous parlez franais, des services dassistance linguistique sont disponibles gratuitement. endstream endobj startxref WebThe reason we cant give a simple yes or no answer is because every insurance company handles cosmetic surgery procedures differently, and since breast implant removal is considered cosmetic surgery, youll have to consult your plans list of covered benefits to determine how much, if any, your insurance company will pay toward this procedure. Two (2) every 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. WebSome have been more receptive than others. EUmsCd}]'`d w! M All changes will take effect Jan. 1, 2022. 2005 - 2023 WebMD LLC. Grade II:Breast is less soft and the implant can be palpated but is not visible. <> For instance, some insurers won't cover diseases of the breast - including breast cancer -- if you have breast implants. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Any advice? "03X2002$n0(Sh*lB4|P `vc ; 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. 500 Reconstructive breast surgery not meeting the criteria as indicated in this policy is considered not medically necessary. Prescriptions, services or supplies ordered, performed, or furnished by you or your immediate relatives or household members, such as spouse, parents, children, brothers, or sisters by blood, marriage, or adoption. In such circumstances the specialty drug 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. Includes codes L8000, L8002, L8010, L8015, and S8460. 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. Suite 1000, 450 Sutter St San Francisco, CA 94108, Introduction to FTM, FTN, MTF and MTN Top Surgery. Self Only biweekly premiums will be $3.56 LU . Mayo Clinic: "Breast Augmentation: Breast Implants Reshape Self-Image." Complications of breast implants are common and may require removal of the implant. 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. Nipple prosthesis, reusable, any type, each. Nipple tattooing is considered cosmetic for all other indications. ID 1-800-472-2689TTY: 711. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral. endstream endobj 1153 0 obj <. 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 This is a fixed cost price with unlimited follow up. : , . All rights reserved. American Society for Aesthetic Plastic Surgery. Surgery* on the contralateral breast to produce a symmetrical appearance after removal of an implant and reimplantation may be considered reconstructive and medically necessary: * Types of reconstructive surgical procedures on the diseased breast include, but are not limited to: Surgery on the contralateral breast to produce symmetry not meeting the criteria as indicated in this policy is considered not medically necessary. Membership or concierge service fees charged by a healthcare provider. Other insurance types such as disability insurance, motor vehicle insurance, prescription card plans and workers' compensation. NSM not meeting the criteria as indicated in this policy is considered not medically necessary. WebScreening uses include screening for breast cancer in patients who are at high genetic risk for breast cancer. 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. There are lots of implant options out there. Transverse rectus abdominis myocutaneous flap (TRAM), latissimus dorsi flap or free flap. (Ak ] *Your benefits and coverage may vary. endobj 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. Self Plus One biweekly premiums will be $289.61 Includes codes L8020, L8030, L8031, L8032, and L8039. 1114 0 obj <>stream Blue Cross Blue Shield is unlikely to cover breast reduction surgery if you want it for cosmetic reasons. $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. %PDF-1.5 % * Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. 3 0 obj Furniture (other than medically necessary durable medical equipment) such as commercial beds, mattresses, chairs. Good luck. 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. New Supplemental International Travel Insurance Member Discounts Take advantage of member-only discounts on health-related products and services. h0N``r4:pV}/bI32kiXrAy c:&[ Blue Cross and Blue Shield of North Carolina will not assign specific length of stay for patients having a mastectomy. This specialized team of clinical experts, mental health experts, and psychiatrists is available for comprehensive support. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. Insurance companies don't cover breast implants for "cosmetic" purposes. Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele1-800-472-2689 TTY: 711). Self Only biweekly premiums will be $127.47 Nipple sparing/skin sparing mastectomy may be considered medically necessary when there is no cancer involving the skin, nipple or areola. endstream endobj startxref Pain: In general, breast augmentation is tolerated very well. endstream endobj 1071 0 obj <>stream hbbd```b``3A$dll{0&S*`@RfKk@d7 Dm`:$5s2012 e bh Surgery on the Contralateral Breast to Produce Symmetry. Individuals, regardless of BSA, who are anticipated to have at least 1 kg. Services, Drugs, and Supplies Provided Overseas, Non-FEHB Benefits Available to Plan Members. %%EOF 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. Includes codes L8000, L8001, L8002, L8010, and L8015. I'm currently pear shaped. 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. q/J 1-800-472-2689( . . .: 711). The 35 local member companies of the Blue Cross Blue Shield Association are the primary points of contact for Service Benefit Plan members. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. 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. Basic Option: Mental Health and Substance Use Disorder Benefits, 5(h). Medicare Advantage members, please call 877-817-0493 all other members please call, 877-817-0477. The Blue Cross and Blue Shield Association is a national federation of 34 independent, community-based and locallyoperated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans.