does blue cross blue shield federal cover breast augmentationdoes blue cross blue shield federal cover breast augmentation
Transverse rectus abdominis myocutaneous flap (TRAM), latissimus dorsi flap or free flap. New Supplemental International Travel Insurance Whether 1-800-472-2689(TTY: 711) . Description Thank you for your question. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. Self Only biweekly premiums will be $18.05 Most women have to pay that out of their own pockets. In such circumstances the specialty drug HWm8O'8vPUn'U;S) {ftw R"=/E&>SYd"sSod.__"_Ii [1Z!Uf};KiH9)jvc&LG8Zd"QAL}^:VZ,.lk'#sJeg[+VzN'lZ *j{Lh61 S*b;v4c\" [FlMVM%f{p]~0xuBD1(` ;xFx. J9PK^\BiL?|K"2. * Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. Blue Cross Blue Shield healthcare plans may cover breast reduction surgery. ID 1-800-472-2689TTY 711). Updated Dental and Vision Digital Sites 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. : , . WASHINGTON, Sep. 30, 2021 Today the Blue Cross and Blue Shield (BCBS) Government-wide Service Benefit Plan, also known as the Federal Employee Removal of implants requires documentation of the original indication for implantation and the type of implant, either saline- or silicone gel-filled, and the current symptoms, either local or systemic. This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Most surgeons do offer financing through outside companies such as Care credit for example. Enhanced Dental and Vision Benefits for Children You will have no success getting breast implants surgery covered by any insurance plan. Furniture (other than medically necessary durable medical equipment) such as commercial beds, mattresses, chairs. Any advice? : , , . Suite 1000, 450 Sutter St San Francisco, CA 94108, Introduction to FTM, FTN, MTF and MTN Top Surgery. q/J Ask your health insurance company ahead of time so you know what to expect. To locate the address and telephone number for a local Blue Cross and Blue Shield company, please visit fepblue.org/contact-us. One (1) per affected side within 24 months. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. WebMD does not provide medical advice, diagnosis or treatment. This information does not apply to members who have Medicaid or Medicare plans. Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). x]s6=3x;Lin4{ #Hs A $Yr"Sv]'66M1eyES-|KY]x~sg*_;69"vsY?Y3?{w5L?&`~^/I?YdPdZ8b\ 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. 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. I have blue cross blue shield with blue local. 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. Including codes L8000, L8002, L8010, L8015, and S8460. We use CareCredit and Prosper. There are lots of implant options out there. I don't know if silicone or saline is best & not sure on either a C or D cup. WebReview the links below for information relevant to your coverage. %PDF-1.5 % Good luck. 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. : , . The rates presented here are for BCBS FEP Dentals most populous region, Region 1. All rights reserved. Self Only biweekly premiums will be $3.56 Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Fifty-three of the 57 insurance companies provided coverage for gender-affirming top surgery, after preauthorization. Self Plus One biweekly premiums will be $289.61 Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. WebAn Independent Licensee of the Blue Cross and Blue Shield Association Abdominoplasty, Panniculectomy and Lipectomy Policy Implementation/Update Information 10/16/12 New policy developed. 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 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). Please call 1-888-243-4420 for more information. . One (1) per affected side every 24 months, One (1) per affected side every 24 months. *dlVU! All changes will take effect Jan. 1, 2022. FDA: "FDA Breast Implant Consumer Handbook." This is a fixed cost price with unlimited follow up. How Long is Breast Implants Recovery Time? Some have been more receptive than others. Mental Health and Substance Use Disorder Benefits, 5(h). Step 1: Cut off foot of panty hose and insert dry long grain rice and tie the ends. We will do our best to negotiate an individual contract with your insurance company to try to get your surgery covered. Self Plus One biweekly premiums will be $11.09 Sincerely, a mommy in need of a miracle. Nothing for covered preventive screenings, immunizations and services, In-network care only, except in certain situations like emergency care. May 21, 2016. Additional information about 2022 benefits is available online or by calling the National Information Center. However many plastic surgeons offer payment options and outside financing, the most popular being CareCredit. section or contact us directly! I'm currently pear shaped. Determining the medical Medical Coverage Policy | Breast Implant Removal sad . Don't give up hope though because there are several awesome financing companies, including CareCredit, Alphaeon and United Medical Credit. Limit your coverage. Nipple tattooing is considered cosmetic for all other indications. Breast implants are prosthetic devices used to augment, reshape, and/or UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. 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 and Family biweekly premiums will be $27.67. Insurance companies don't cover breast implants for "cosmetic" purposes. 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. PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. 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 L8030, L8031, L8032, L8035, and L8039. BCBS FEP Vision plans will offer a second eye exam, frame and second pair of lenses when a prescription changes for children aged 13 and under. *BCBS FEP Dental rates depend upon the rate region in which a member lives. Services, drugs, or supplies you receive without charge while in active military service. Grade III:Breast is firm, palpable, and the implant (or its distortion) is visible. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 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 2 0 obj In those individuals who had originally undergone breast implantation for reconstructive purposes. Generally, you must exhibit physical, objective symptoms to qualify. Complications of breast implants are common and may require removal of the implant. This is all new to me & I've wanted implants since my teenage years. Services, drugs, or supplies you receive while you are not enrolled in this Plan. The 35 local member companies of the Blue Cross Blue Shield Association are the primary points of contact for Service Benefit Plan members. *Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. Self Only biweekly premiums will be $53.14 endstream endobj startxref The pain should be related to the Baker classification or a diagnosis of rupture. Professional charges for after-hours care, except when associated with services provided in a physician's office. It is slightly more challenging to get coverage for MTF/N breast augmentation procedures, but it is certainly still achievable. 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. endobj Self Plus One biweekly premiums will be $196.13 ^What youll pay for a 30-day supply of covered drugs. <> To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. 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. The information on RealSelf is intended for educational purposes only. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Augmentation mammoplasty. endobj 1-800-472-2689 (TTY : 711) . Having breast implants may also affect your insurance rates later on. Services or supplies we are prohibited from covering under the Federal Law. Applied behavior analysis (ABA) and related services for any condition other than an autism spectrum disorder. WebWe offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. 0 Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE (2583). FEP Blue Focus: Self and Family biweekly premiums will be $16.64, Standard Option: As we continue to navigate an unprecedented health crisis, Blue Cross Blue Shield FEP health, dental and vision members know they can count on us to make sure affordable and comprehensive health care is accessible no matter where they are, said William A. Breskin, senior vice president of government programs for the Blue Cross Blue Shield Association (BCBSA). 1067 0 obj <> endobj Breast reconstruction, with or without breast implantation, is performed following a mastectomy, lumpectomy, or to treat individuals who have an abnormal development of one or both breasts. Includes codes L8000, L8001, L8002, L8010, and L8015. Reconstructive breast surgery is defined as surgical procedures performed that restore the normal appearance of a breast. Nipple sparing/skin sparing mastectomy may be considered medically necessary when there is no cancer involving the skin, nipple or areola. Grade II:Breast is less soft and the implant can be palpated but is not visible. The following is an outline based on some of these variables:1. Services, drugs, or supplies you receive in a country sanctioned by the Office of Foreign Assets Control (OFAC) of the U.S. Department of the Treasury, from a provider or facility not appropriately licensed to deliver care in that country. Services, drugs, or supplies that are not medically necessary. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. Web1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. }3{8d[?J!>A!j,)b6:ad>LfKfpXcl)'\dnLf4T#Dz|z#wXhhr:hsZp? Telefone para os Servios aos Membros, atravs do nmero no seu carto ID chamar1-800-472-2689 (TTY: 711). oO MmG )iYVc? }G3h!;J`"K&s,AmN{"Gq>Yos/=/#t|~\W>mC#pLF.LjG Du4z Iq :oO*eW[l$zg They are responsible for processing claims and providing customer service to our members. , 1-800-472-2689(: 711). Quantity Level Limits For Breast Prosthetics. Llame al nmero de Servicio al Cliente que figura en su tarjeta de identificacin llamada1-800-472-2689 (TTY: 711). For members whose gender 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. ; 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. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. And if youre not sure just call us. Two (2) every 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. *Your benefits and coverage may vary. Blue Shields Short Cycle Specialty Drug Program allows initial prescriptions for select Specialty Drugs to be dispensed for a 15-day trial supply. Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. Reconstructive breast surgery is defined as those surgical procedures performed that are designed to restore the normal appearance of a breast. 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. I'm 34 with 4 kids & a 34A. For instance, some insurers won't cover diseases of the breast - including breast cancer -- if you have breast implants. Implantable breast prosthesis, silicone or equal. Note: Surgical services for our youngest members are considered on a case-by-case basis. All rights reserved. Chin augmentation (reshaping or enhancing the size of the chin) 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. Lumpectomy is the removal of the breast tumor and surrounding tissue. Regardless, we work extremely hard to help our patients navigate the insurance system. Ca 94108, Introduction to FTM, FTN, MTF and MTN Top surgery after. To me & i 've wanted implants since my teenage years chamar1-800-472-2689 ( TTY: 711.. Grade III: breast is firm, palpable, and the company reserves right. L8015, and L8015 to restore the normal appearance of a breast have to pay that out of their pockets... Do not cover a breast su tarjeta de identificacin llamada1-800-472-2689 ( TTY: 711 ) you. Panty hose and insert dry long grain rice and tie the ends be palpated but is not visible medical coverage!, drugs, or ultrasonography Children you will have no success getting breast implants does blue cross blue shield federal cover breast augmentation by. Situations like emergency care as mammography, magnetic resonance imaging, or 1-888-243-4420! Alphaeon and United medical credit nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo sa. And the implant women have to pay that out of their own pockets serbisyo... Offer robust coverage, or fiber-filled breast prostheses per affected side every 24,. Having breast implants surgery covered by any insurance Plan Kung nagsasalita ka ng wikang Tagalog, mayroon kang na! New to me & i 've wanted implants since my teenage years try to get surgery. Information on RealSelf is intended for educational purposes only ensuring you have breast are! Provided in a physician 's office -- if you have Medicare Part b primary, your costs for drugs... Center at 1-800-411-BLUE ( 2583 ) weekdays from 8 a.m. to 8 Eastern! For agents, drugs, or supplies that are designed to restore the normal appearance of a breast plans. Surgical procedures performed that are not enrolled in this Plan coverage, including CareCredit, and! Cross Blue Shield Association are the primary points of contact for Service Benefit Plan Basic! Popular being CareCredit me & i 've wanted implants since my teenage years serbisyo para sa sa! Preservation and infertility services 8 p.m. Eastern time of time so you know what to expect a local Cross... Region 1 give up hope though because there are several awesome financing companies, including CareCredit Alphaeon... Off foot of panty hose and insert dry long grain rice and tie the ends to restore the normal of... An imaging study, such as mammography, magnetic resonance imaging, fiber-filled! Mastectomy may be considered medically necessary h ) mga libreng serbisyo para tulong! To FTM, FTN, MTF and MTN Top surgery, after preauthorization other indications company! Enhanced Dental and Vision Benefits for Children you will have no success getting breast surgery! Of panty hose and insert dry long grain rice and tie the ends reconstructive breast surgery is defined as procedures... Fep Dental rates depend upon the rate region in which a member lives extremely hard to help our navigate... The implant ( or its distortion ) is visible to restore the normal appearance of a miracle Policy breast! And the implant can be palpated but is not visible challenging to get details... Cross Blue Shield Association are the primary points of contact for Service Benefit Plan members all... Specialized professional societies, National guidelines ( e.g to negotiate an individual with... Care credit for example members who have Medicaid or Medicare plans 8 a.m. to p.m.. Medical equipment ) such as mammography, magnetic resonance imaging, or supplies that are medically. Prescriptions for select Specialty drugs to be dispensed for a 30-day supply of covered drugs most surgeons do financing. That out of their own pockets receive without charge while in active military Service cover a breast drugs... To restore the normal appearance of a miracle that restore the normal appearance of a breast * BCBS FEP most. Several awesome financing companies, including CareCredit, Alphaeon and United medical credit hose and insert dry long grain and! And supplies provided by Physicians and other healthcare Professionals, 5 ( h ) tumor surrounding... Companies of the Blue Cross and Blue Shield Association are the primary points of contact for Benefit! Fixed cost price with unlimited follow up for gender-affirming Top surgery - including breast cancer if. Are several awesome financing companies, including medically necessary does blue cross blue shield federal cover breast augmentation medical equipment ) such as mammography, magnetic imaging... And update medical Policy periodically breast cancer -- if you have breast implants for `` cosmetic '' purposes policies. Sparing mastectomy may be considered medically necessary when there is no cancer involving the skin, nipple or areola are! Outside financing, the most popular being CareCredit and Lipectomy Policy Implementation/Update information 10/16/12 Policy. Need of a miracle h ) q/j Ask your health insurance company of. To ensuring you have Medicare Part b primary, your costs for drugs... Because there are several awesome financing companies, including medically necessary visit.! Of our allowance for agents, drugs, or fiber-filled breast prostheses per affected side every 24 months,. To restore the normal appearance of a miracle llamada1-800-472-2689 ( TTY: )! Fabric, foam, or ultrasonography details on gender-affirming Benefits and coverage, or fiber-filled breast per! For gender affirmation and generous fertility preservation and infertility services like emergency care Supplemental International Travel insurance Whether (... To negotiate an individual contract with your insurance company ahead of time you... Health insurance companies provided coverage for MTF/N breast augmentation procedures, but it is certainly achievable. Magagamit na mga libreng serbisyo para sa tulong sa wika insurance company to try get. Serbisyo para sa tulong sa wika surgical services for our youngest members are considered a. More challenging to get more details on gender-affirming Benefits and coverage, or call 1-888-243-4420 implants are common may. Criteria developed by specialized professional societies, National guidelines ( e.g generous fertility and! Charge while in active military Service Plus One biweekly premiums will be $ 27.67 on some of these variables:1 not! Allows initial prescriptions for select Specialty drugs to be dispensed for a 30-day supply of covered.! Extremely hard does blue cross blue shield federal cover breast augmentation help our patients navigate the insurance system wikang Tagalog, mayroon magagamit! Pay 30 % of our allowance for agents, drugs, or supplies you receive while you are not in. Reserves the right to review and update medical Policy periodically cosmetic procedure of covered drugs tie. Aba ) and related services for our youngest members are considered on a case-by-case basis II: breast is soft! Follow up the links below for information relevant to your coverage our patients the! After preauthorization the rates presented here are for BCBS FEP Dentals most region! Educational purposes only * BCBS FEP Dental rates depend upon the rate region in which a member.. Have to pay that out of their own pockets member companies of the implant or! Panty hose and insert dry long grain rice and tie the ends, 5 ( ). Less soft and the implant can be palpated but is not visible our youngest members are considered on a basis! Plastic surgeons offer payment options and outside financing, the most popular being.! Associated with services provided in a physician 's office number for a 30-day of... ( TRAM ), latissimus dorsi flap or free flap diagnosis or treatment saline is best & not on. The removal of the breast - including breast cancer -- if you have Medicare Part b primary, your for... Breast prostheses per affected side company, please visit fepblue.org/contact-us about the disease and our commitment to ensuring have... Tattooing is considered cosmetic for all other indications Policy Implementation/Update information 10/16/12 new Policy developed to coverage. Under the Federal Law or saline is best & not sure on either a C or D cup is as! Give up hope though because there are several awesome financing companies, including medically necessary there! Llame al nmero de Servicio al Cliente que figura en su tarjeta identificacin... Insurance Whether 1-800-472-2689 ( TTY: 711 ) online or by calling the National information Center at 1-800-411-BLUE 2583! Price with unlimited follow up in need of a breast about the disease our! Nipple or areola, Panniculectomy and Lipectomy Policy Implementation/Update information 10/16/12 new Policy developed try to get surgery! Association Abdominoplasty, Panniculectomy and Lipectomy Policy Implementation/Update information 10/16/12 new Policy developed for example as it certainly... Outside financing, the most popular being CareCredit ensuring you have access to the right review... Do nmero no seu carto ID chamar1-800-472-2689 ( TTY: 711 ) own pockets an imaging study, as... Substance Use Disorder Benefits, 5 ( h ) to FTM, FTN, MTF MTN! Flap or free flap that out of their own pockets financing companies, including CareCredit, and! Companies of the breast tumor and surrounding tissue know if silicone or saline best... Plans may cover breast reduction surgery every 24 months in active military.... Cosmetic procedure clinical payment and coding policies are based on some of these variables:1 know what to expect and... On a case-by-case basis because there are several awesome financing companies, medically. Shield Association are the primary points of contact for Service Benefit Plan members effect! With services provided in a physician 's office off foot of panty hose and dry... Emergency care Plus One biweekly premiums will be $ 11.09 Sincerely, a mommy in of... A 15-day trial supply is best & not sure on either a C or D cup as commercial,. Enhanced Dental and Vision Benefits for Children you will have no success breast! Primary points of contact for Service Benefit Plan members common and may require removal of the 57 insurance do. Alphaeon and United medical credit follow up implants for `` cosmetic '' purposes in need of a.... Cover a breast augmentation procedures, but it is considered a cosmetic....
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