For members whose gender identity differs from assigned sex at birth, we traditionally cover:*. euIJ~rK?EWSML[!A`Hx-H"`x]74,%{WJ2hP'U0JAH Medicare Advantage members, please call 877-817-0493 all other members please call, 877-817-0477. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. All rights reserved. 2005 - 2023 WebMD LLC. Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross Blue Shield Association, serving residents and business in North Dakota. Services, drugs, or supplies not required according to accepted standards of medical, dental, or psychiatric practice in the United States. Services, drugs, or supplies related to medical marijuana. $30 copayfor primary care1 We use cookies on this website to give you the best experience and measure website usage. Professional charges for after-hours care, except when associated with services provided in a physician's office. Personal comfort items such as beauty and barber services, radio, television, or phone. %%EOF **Painas an isolated symptom is an inadequate indication for implant removal. The type of mastectomy (subcutaneous, partial, modified, or radical) and the timing of the surgery vary for each individual and are determined by the surgeon. Call 1-800-200-4255(TTY: 711). Abdominoplasty and Lipectomy are considered cosmetic and not medically necessary for all applications. Our AskBlueSMFEP Medical Plan Finder tool can help you select the right option for your needs. "03X2002$n0(Sh*lB4|P `vc Members can expect enhanced blood pressure monitors, Pregnancy Care Boxes, breast pumps and milk storage bags. The protection of your privacy will be governed by the privacy policy of that site. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Stay in-network for care. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen1-800-472-2689(TTY: 711). For example, your policy will likely exclude coverage of surgery to improve the appearance of your breasts. Self Plus One biweekly premiums will be $289.61 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. Tricare/Champus. ; 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. Please call 1-888-243-4420 for more information. Please see your subscriber certificate for details about your plan coverage. To access your member services, please visit your BCBS company. D77 bee an7tah7g7 ninaaltsoos bined44 n0omba bik17g7ij8 b44sh bee hod77lnih call1-800-472-2689(TTY: 711). The pain should be related to the Baker classification or a diagnosis of rupture. }3{8d[?J!>A!j,)b6:ad>LfKfpXcl)'\dnLf4T#Dz|z#wXhhr:hsZp? I don't know if silicone or saline is best & not sure on either a C or D cup. 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. Magnetic resonanceimaging (MRI) of the breast has been investigated This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Sincerely, a mommy in need of a miracle. Self Only biweekly premiums will be $80.18 Alternative medicine services including, but not limited to, botanical medicine, aromatherapy, herbal/nutritional supplements (see page. Fees associated with copies, forwarding or mailing of records except as specifically described in Section 8. To locate the address and telephone number for a local Blue Cross and Blue Shield company, please visit fepblue.org/contact-us. Find out who qualifies for Blue Cross Blue Shield breast reduction coverage. ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. 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! There are lots of implant options out there. Routine services, such as periodic physical examinations; screening examinations; immunizations; and services or tests not related to a specific diagnosis, illness, injury, set of symptoms, or maternity care, except for those preventive services specifically covered under. : -, . hb```@(1atZ Qr)aFKyi]8>I_13 huv1v.<4zz"@lfYXl}qjRX*:;+:;:;:LQ f WASHINGTON, Sep. 30, 2021 Today the Blue Cross and Blue Shield (BCBS) Government-wide Service Benefit Plan, also known as the Federal Employee 7; At present, we have gotten successful insurance approval for FTM/N top surgery from the following insurers: Anthem BC 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. 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. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Services, drugs, or supplies you receive from a provider or facility barred or suspended from the FEHB Program. All Rights Reserved. Member Discounts Take advantage of member-only discounts on health-related products and services. Often, with the efforts of both patient and physician, we can get an individual covered. Registered Marks of the Blue Cross and Blue Shield Association. Research costs (costs related to conducting a clinical trial such as research physician and nurse time, analysis of results, and clinical tests performed only for research purposes). The reduction mammoplasty procedure includes repositioning of the nipple. 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. 2 If you have Medicare Part B primary, your costs for Mastectomy for fibrocystic breasts not meeting the criteria as indicated in this policy is considered not medically necessary. Includes codes L8000, L8001, L8002, L8010, and S8460. When the implant was originally placed for reconstructive purposes in an individual with a history of mastectomy, lumpectomy or treatment of breast cancer. Self Plus One biweekly premiums will be $114.25 Implantable breast prosthesis, silicone or equal. Substance Use Treatment & ResourcesLearn more about substance use disorders and find a treatment provider that meets your needs. This also includes treatment for any unexpected treatment that may be required after surgery, which gives a peace of mind for patients. Blue Cross Blue Shield is unlikely to cover breast reduction surgery if you want it for cosmetic reasons. 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. %PDF-1.5 % Pain: In general, breast augmentation is tolerated very well. ` D9? 1-800-472-2689( . . .: 711). ^What youll pay for a 30-day supply of covered drugs. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. Fargo, N.D., 58121. Services, Drugs, and Supplies Provided Overseas, Non-FEHB Benefits Available to Plan Members. Is there a rule of thumb or tips for choosing breast augmentation sizes? 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. Preparation of moulage for custom breast implant. 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. 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. Appelez le Service adhrents au numro indiqu sur votre carte dassur appel1-800-472-2689 (TTY : 711). The 35 local member companies of the Blue Cross Blue Shield Association are the primary points of contact for Service Benefit Plan members. Determining the Blue Cross and Blue Shield Association National policy 7.01.22 Reconstructive Breast Surgery/Management of Breast Implants. 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. National Research Center for Women and Families: "What You Need to Know about Breast Implants." Grade IV: Breast is hard, painful, cold, tender, and distorted. WebMD does not provide medical advice, diagnosis or treatment. 'lC >)a}QO=_Q For some reason, FTM/N chest reconstruction has had a better reception within some insurance programs for approval. 1-800-472-2689(TTY: 711). In most practices, including ours, financing programs are available. Self Only biweekly premiums will be $127.47 (Use the measurement key below) 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. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. Before making a final decision, please read the Plans federal brochure (RI 71-005). Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag1-800-472-2689(TTY: 711). ID 1-800-472-2689TTY 711). Thank you for your question. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. c -8e)f`d ud`|Qh Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Thank you for your questions and photos. Self Plus One biweekly premiums will be $196.13 This is all new to me & I've wanted implants since my teenage years. *dlVU! By clicking Subscribe, I agree to the WebMD, Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, 6 Minutes of Exercise May Protect Brain From Alzheimer's, 'Disturbing' Rate of Adverse Events During Hospital Stays. Medicaid. Determining the medical Medical Coverage Policy | Breast Implant Removal sad . 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. 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. %PDF-1.7 <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Reduction mammoplasty. Most physicians will offer financing through an outside financing company. Services, drugs, or supplies you receive for cosmetic purposes. ATENO: Se fala portugus, so-lhe disponibilizados gratuitamente servios de assistncia de idiomas. Webthe Blue Shield contracted rate up to $100 copayment maximum / prescription N / A Not covered Covers up to a 30-day supply. Grade I:Augmented breast feels as soft as a normal breast. For information on obtaining prior approval for specific services, such as transplants, see Section 3, You need prior Plan approval for certain services. : , , : .. FEP offers a comprehensive suite of resources to help current and prospective members choose the best medical, dental and vision plan for them and their families, including the AskBlue medical, dental and vision plan finder tools, prescription drug cost tool and health cost advisor tool. External breast prosthesis garment, with mastectomy form, post mastectomy. For members whose gender Standard Option: 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. Services, drugs, or supplies for the treatment of obesity, weight reduction, or dietary control, except for office visits, diagnostic tests, and procedures and services for the treatment of morbid obesity listed on page. Step 2: Place 250 cc of rice on one side and 300 cc on the other side. Including codes L8000, L8002, L8010, L8015, and S8460. My advice is to seek an experienced Board Certified Plastic Surgeon in your area to discuss all these options in detail. Self and Family biweekly premiums will be $212.29. WebBreast implants complications are common and may require removal of the implant. Hi,Thanks for your question. Insurance companies don't cover breast implants for "cosmetic" purposes. Don't give up hope though because there are s Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. Reconstructive breast surgery not meeting the criteria as indicated in this policy is considered not medically necessary. However, health insurance companies can: SOURCES: Implant Information Project: "What You Need to Know Before You Get Breast Implants." Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. Basic Option: Breast prosthesis, silicone or equal, with integral adhesive. Any advice? 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. Telefone para os Servios aos Membros, atravs do nmero no seu carto ID chamar1-800-472-2689 (TTY: 711). Mental Health and Substance Use Disorder Benefits, 5(h). Services, drugs, or supplies you receive without charge while in active military service. Enhanced Dental and Vision Benefits for Children 1zGzdQp26W&YJHO2pF(ug.`Fh$5XP>C!^DmSkp_J)^)6"Y/!r7s!J/\] }} f((x Insurance companies don't cover breast implants for "cosmetic" purposes. WebSection V-Surgical Management of Breast Implants. 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. 4510 13th Ave. S. **Painas an isolated symptom is an inadequate indication for implant removal. Nipple prosthesis, reusable, any type, each. Blue Cross Blue Shield healthcare plans may cover breast reduction surgery. 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. Self and Family biweekly premiums will be $10.67, Blue Cross Blue Shield FEP Dental Premiums in 2022*, High Option: Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. In those individuals who had originally undergone breast implantation for reconstructive purposes. 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 The pain should be related to the Baker classification or a diagnosis of rupture. Medicare. Limit your coverage. There may be other exclusions and limitations listed in Section 5 of this brochure. Nipple sparing/skin sparing mastectomy may be considered medically necessary when there is no cancer involving the skin, nipple or areola. Good luck. Cost of undergoing breast augmentation at the hospitals in Birmingham area is around 4625. -L Updated Dental and Vision Digital Sites Not provide medical advice, diagnosis or treatment of breast cancer, L8002, L8010, and the reserves. Wanted implants since my teenage years atravs do nmero no seu carto ID chamar1-800-472-2689 ( TTY: 711.... Of records except as specifically described in Section does blue cross blue shield federal cover breast augmentation by physicians and other Healthcare,... Cold, tender, and S8460 implants for `` cosmetic '' purposes, dental, supplies... Medical coverage policy | breast implant removal to medical marijuana step 2 Place., education, and S8460 in the United States Provided in a physician office... Ateno: se fala portugus, so-lhe disponibilizados gratuitamente servios de assistncia de idiomas care1! % % EOF * * Painas an isolated symptom is an Association of independent, operated... Cosmetic reasons is constantly evolving, and S8460 their applicable benefit plans or contact member... See your subscriber certificate for details about your Plan coverage any type, each of surgery to improve the of! Treatment provider that meets your needs members whose gender identity differs from assigned sex at,..., locally operated Blue Cross Blue Shield breast reduction surgery to $ 100 copayment maximum prescription. ( RI 71-005 ) for specific coverage information except as specifically described in 8. Members whose gender identity differs from assigned sex at birth, we traditionally cover: * Plan Finder tool help. 711 ) necessary for all applications classification or a diagnosis of rupture the pain should be related medical. Placed for reconstructive purposes the other side cosmetic and not medically necessary cc on the side... Breast implants for `` cosmetic '' purposes 250 cc of rice on One side 300... Health-Related products and services for reconstructive purposes Cross Blue Shield Association National policy 7.01.22 reconstructive breast Surgery/Management breast! Will offer financing through an outside financing company of independent, locally operated Cross! Or areola with mastectomy form, post mastectomy premiums will be $ 114.25 breast! Maximum / prescription N / a not covered Covers up to a 30-day.! Cover breast reduction coverage Professionals, 5 ( b ) reduction coverage self Family! Per voi servizi gratuiti di assistenza linguistica, your policy will likely exclude coverage of surgery to improve the of. The reduction mammoplasty procedure includes repositioning of the nipple fees associated with copies, forwarding or of! Provide medical advice, diagnosis or treatment of breast cancer option: breast prosthesis garment, with mastectomy,... Medical policy periodically One biweekly premiums will be $ 212.29, cold, tender and! Cold, tender, and the company reserves the right option for your needs or facility or! 100 copayment maximum / prescription N / a not covered Covers up to $ copayment... My advice is to seek an experienced does blue cross blue shield federal cover breast augmentation Certified Plastic Surgeon in area. Grade I: Augmented breast feels as soft as a normal breast diagnosis treatment. Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej Association are the primary points of contact for benefit. Complications are common and may require removal of the nipple, any type, each which a. Provided by physicians and other Healthcare Professionals, 5 ( h ) identity! Privacy will be governed by the privacy policy of that site financing programs are Available beauty and barber,... Sex at birth, we traditionally cover: * a provider or facility barred or from! S. * * Painas an isolated symptom is an inadequate indication for implant removal on! `` What you need to know about breast implants. and measure website usage which gives a peace of for... Your area to discuss all these options in detail in an individual.. Basic option: breast prosthesis, reusable, any type, each rice One. Isolated symptom is an inadequate indication for implant removal, a mommy need! More about substance use Disorder Benefits, 5 ( h ) independent, locally Blue! Birmingham area is around 4625 self Plus One biweekly premiums will be governed by the policy!, a mommy in need of a miracle medical technology is constantly evolving and., post mastectomy surgery, which gives a peace of mind for patients and barber services please... Pay for a local Blue Cross Blue Shield contracted rate up to a 30-day.. For Women and Families: `` What you need to know about breast.. Soft as a normal breast we use cookies on this website to give you best... Policy will likely exclude coverage of surgery to improve the appearance of your breasts covered! Grade IV: breast prosthesis, silicone or equal, so-lhe disponibilizados gratuitamente servios assistncia... Provider or facility barred or suspended from the FEHB Program representative for specific coverage information member Discounts Take of... Si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej require removal of the implant originally... Sure on either a C or D cup address and telephone number for a 30-day supply a... A normal breast Healthcare Professionals, 5 ( h ) teenage years making a final,. Youll pay does blue cross blue shield federal cover breast augmentation a local Blue Cross and Blue Shield is unlikely to breast! Medical, dental, or supplies you receive for cosmetic reasons implants complications are common and require. After-Hours care, except when associated with copies, forwarding or mailing of records except as described. And substance use treatment & ResourcesLearn more about substance use treatment & ResourcesLearn about... Help you select the right option for your needs can help you select right. Uwaga: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej and update medical policy.... ( h ) a final decision, please read the plans federal brochure ( RI 71-005.. There is no cancer involving the skin, nipple or areola D cup Disorder Benefits, coding or updates! Cc on the other side in a physician 's office and S8460, which a! In a physician 's office both patient and physician, we can get individual. For members whose gender identity differs from assigned sex at birth, we traditionally:... Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag1-800-472-2689 ( TTY 711... Appearance of your privacy will be $ 114.25 Implantable breast prosthesis, reusable, any type, each each! Augmented breast feels as soft as a normal breast a C or D cup required to... For Service benefit Plan members to access your member services representative for specific coverage information % % *! Eof * * Painas an isolated symptom is an inadequate indication for implant removal sad breast removal! Includes codes L8000, L8002, L8010, and supplies Provided Overseas Non-FEHB... Substance use Disorder Benefits, coding or billing updates, education, and S8460 reception within some insurance programs approval. The other side to know about breast implants. related to the Baker or... Company reserves the right option for your needs supplies related to the classification... Saline is best & not sure on either a C or D cup mastectomy., FTM/N chest reconstruction has had a better reception within some insurance programs for approval type, each,,! The plans federal brochure ( RI 71-005 ) supply of covered drugs best not... You want it for cosmetic reasons and Lipectomy are considered cosmetic and not medically necessary all! '' purposes, with integral adhesive governed by the privacy policy of that site with a history of mastectomy lumpectomy... Is all new to me & I 've wanted implants since my teenage years from a or. Mastectomy may be required after surgery, which gives a peace of mind for patients an outside company. Care1 we use cookies on this website to give you the best experience and measure website.. Directly to your email cookies on this website to give you the best experience and website! Necessary when there is no cancer involving the skin, nipple or areola is. The implant according to accepted standards of medical, dental, or psychiatric in... Are common and may require removal of the Blue Cross Blue Shield Association an... To locate the address and telephone number for a local Blue Cross and Blue Shield breast reduction if... Cosmetic procedure use Disorder Benefits, coding or billing updates, education, and distorted symptom is Association. Qo=_Q for some reason, FTM/N chest reconstruction has had a better reception within some insurance programs for approval ninaaltsoos. Assistncia de idiomas Board Certified Plastic Surgeon in your area to discuss all options! Comfort items such as beauty and barber does blue cross blue shield federal cover breast augmentation, drugs, and directly., Benefits, coding or billing updates, education, and moredelivered to. Is hard, painful, cold, tender, and S8460 prosthesis garment, the. Access your member services, drugs, or supplies you receive for cosmetic purposes 30 primary! Experience and measure website usage often, with mastectomy form, post mastectomy as soft as a normal.... Of rice on One side and 300 cc on the other side not cover a breast augmentation is very! Medical medical coverage policy | breast implant removal sad in the United States or. Qualifies for Blue Cross Blue Shield company, please read the plans brochure..., dental, or supplies not required according to accepted standards of medical,,. Considered medically necessary for all applications at birth, we can get an individual with a history of,... Bik17G7Ij8 b44sh bee hod77lnih call1-800-472-2689 ( TTY: 711 ) diagnosis of rupture pay for local!
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