Furniture (other than medically necessary durable medical equipment) such as commercial beds, mattresses, chairs. ID 1-800-472-2689TTY 711). We use cookies on this website to give you the best experience and measure website usage. Removal of a silicone gel-filledbreast implant may be considered medically necessary: Removal of a saline-filledbreast implant may be considered medically necessary forEITHERof the following indications: Removal of a breast implant associated with a Baker class III contracturemay be considered medically necessary: The following indications for removal of breast implants are considerednot medically necessary: Removal of breast implant not meeting the criteria as indicated in this policy is considered not medically necessary. 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). One (1) per affected side every 24 months, One (1) per affected side every 24 months. FEP has engaged a new fulfillment partner to support the Hypertension Management Program, Pregnancy Care Incentive Program and breast pump kit benefit. Transverse rectus abdominis myocutaneous flap (TRAM), latissimus dorsi flap or free flap. *dlVU! BCBSNC does not provide coverage for not Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. 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. hbbd``b`~ H ,f@]bXu $UW4 bV+X ``0 \] 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. Nipple tattooing is considered cosmetic for all other indications. Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals, 5(c). Preparation of moulage for custom breast implant. Self and Family biweekly premiums will be $212.29. %%EOF Chin augmentation (reshaping or enhancing the size of the chin) 4510 13th Ave. S. If you are facing this surgery, take some comfort in knowing that federal and state laws require Blue Cross Blue Shield is unlikely to cover breast reduction surgery if you want it for cosmetic reasons. Calf implants IV. WebBreast implants complications are common and may require removal of the implant. Self Plus One biweekly premiums will be $11.09 Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral. %vH>jJ(BS+4t|!vLSM z7&^\&gN;ObtGn=M&qbn' IL\] #5!qgu02>/qdV&JUNeHyYYQD-LKR(=#s!R{@*^Gg&lrGAegn[R-{.{/om?DiQiH9e1A The exclusions in this Section apply to all benefits. Services, drugs, or supplies that are not medically necessary. Description Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. 500 The benefits of coconut, argan, tea tree and more. Thank you for your question. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. However, health insurance companies can: SOURCES: Implant Information Project: "What You Need to Know Before You Get Breast Implants." Ask your health insurance company ahead of time so you know what to expect. Includes codes L8030, L8031, L8032, L8035, and L8039. %8eRq xq{2cQ'YzRh(KE&WNO-ID.}16m', ~D[+d\q~0}h(U~LG 1ek[FZOvM) .P=xgu`E)I M p_]pV#g$ RkPGV9& G{(TRp. %PDF-1.7 % For some reason, FTM/N chest reconstruction has had a better reception within some insurance programs for approval. Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first). Grade III: Breast is firm, palpable, and the implant (or its distortion) is visible. We offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. . 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. HZjz:|QkM]h]\ hWmo8+|lu For members whose gender For information on obtaining prior approval for specific services, such as transplants, see Section 3, You need prior Plan approval for certain services. endstream endobj startxref Nipple prosthesis, reusable, any type, each. q/J 3You must be the contract holder or spouse, 18 or older, on a Standard or Basic Option Plan to earn incentive rewards. 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. May 21, 2016. Surgery on the Contralateral Breast to Produce Symmetry. Self Only biweekly premiums will be $80.18 FEP Blue Focus premiums remain flat for fourth consecutive year, Blue Cross and Blue Shield Federal Employee Program (FEP) Introduces Enhanced Hypertension and Pregnancy Programs, Dental and Vision Benefits and New International Travel Insurance, Blue Cross Blue Shield Companies Form Synergie Medication Collective, a New Venture to Radically Improve Affordability and Access to Costly Medications for Millions of Americans, Congress Passes Meaningful Changes to Expand Mental Health Support, Improve Maternal Health, and Lower Costs for Consumers, Blue Cross Blue Shield Association Enhances Blue Distinction Centers for Maternity Care Criteria to Advance Health Equity, New Study: No Surprises Act Protects 9 Million Americans from Surprise Medical Bills, Blue Cross Blue Shield Association Statement on the Election of the 118th Congress, Blue Cross and Blue Shield of Louisiana Offers Services to Members Affected by Hurricane Ida, Blue Cross Of Idaho And The Blue Cross Of Idaho Foundation For Health Commit To Expanding Health Equity Across Idaho, Blue Cross Blue Shield of Wyoming Announces New Board Member, James G. Springfield Named President of Blue Cross and Blue Shield of Texas. You will have no success getting breast implants surgery covered by any insurance plan. 1089 0 obj <>/Filter/FlateDecode/ID[<50450C2B75DCDF4CB37C20535D129F89><28C61A8B7ECC9640B72333AA8FDFF1D6>]/Index[1067 48]/Info 1066 0 R/Length 109/Prev 449243/Root 1068 0 R/Size 1115/Type/XRef/W[1 3 1]>>stream While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. In most practices, including ours, financing programs are available. Blue Cross Blue Shield FEP Vision Premiums in 2022: High Option: Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type, Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral, any size, any type, Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral, any size, any type, External breast prosthesis garment, with mastectomy form, post mastectomy, Breast prosthesis, silicone or equal, without integral adhesive, Breast prosthesis, silicone or equal, with integral adhesive, Nipple prosthesis, reusable, any type, each, Custom breast prosthesis, post mastectomy, molded to individual model, Breast prosthesis, not otherwise specified, Adhesive skin support attachment for use with external breast prosthesis, each, Internal Medical Policy Committee 11-14-2019 Revised policy, Internal Medical Policy Committee 11-19-2020 - Revised policy, Internal Medical Policy Committee 11-23-2021 - Annual Review, no changes in criteria, Internal Medical Policy Committee 3-23-2022 - Revised policy, Internal Medical Policy Committee 11-29-2022 - Coding update -Effective November 30, 2022. Alternative medicine services including, but not limited to, botanical medicine, aromatherapy, herbal/nutritional supplements (see page. Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined inconsultation with the attending physician and the individual. All rights reserved. Check our F.A.Q. Reconstructive breast surgery is defined as those surgical procedures performed that are designed to restore the normal appearance of a breast. Augmentation changes the size and appearance of one or both breasts by transferring body fat to them or adding artificial implants. Member Discounts Take advantage of member-only discounts on health-related products and services. Please see Table Attachment for quantity limits. Dr. Mosser is always actively working with insurance companies to negotiate contracts. Services Provided by a Hospital or Other Facility, and Ambulance Services, 5(e). For more information, view our privacy policy. All rights reserved. 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. Services, drugs, or supplies billed by Preferred and Member facilities for inpatient care related to specific medical errors and hospital-acquired conditions known as Never Events (see definition on page. Self Plus One biweekly premiums will be $18.44 You can also visit our Mental Health Resource Center to learn more. Services not specifically listed as covered. endobj This specialized team of clinical experts, mental health experts, and psychiatrists is available for comprehensive support. And if youre not sure just call us. Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). Self Only biweekly premiums will be $5.55 Self Only biweekly premiums will be $53.14 Member Service 1-800-472-2689(TTY: 711). Includes codes L8001, L8002, L8010, L8015, and S8460. 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. Travel expenses except as specifically provided for covered transplants performed in a Blue Distinction Center for Transplant (see page. WebScreening uses include screening for breast cancer in patients who are at high genetic risk for breast cancer. %PDF-1.7 Call 1-800-200-4255(TTY: 711). Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. 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. FDA: "FDA Breast Implant Consumer Handbook." ATANSYON: Si ou pale kreyl ayisyen, svis asistans nan lang disponib pou ou gratis. Federal employees, annuitants and their family members are eligible for coverage through the FEHB Program, while FEDVIP is available to federal employees and annuitants, certain retired uniformed service members and active duty family members. Hi,Thanks for your question. Pain: In general, breast augmentation is tolerated very well. The protection of your privacy will be governed by the privacy policy of that site. Under Basic Option, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care. WebMinimum proposed specimen weights (both breasts combined) (glandular tissue) should be 0.4 kg for women weighing less the 60 kg (132#), 0.7 kg for women weighing 60-80 kg (132-176#), and 1 kg for women weighing more than 80 kg (176#). Naley zadzwoni do Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689(TTY: 711). One (1) per affected side within 24 months. Before making a final decision, please read the Plans federal brochure (RI 71-005). ATENO: Se fala portugus, so-lhe disponibilizados gratuitamente servios de assistncia de idiomas. Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE (2583). Services, drugs, or supplies you receive from noncovered providers. Thank you for your questions and photos. FEP Blue Focus: 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, L8001, L8002, L8010, and S8460. In such circumstances the specialty drug Self Plus One biweekly premiums will be $196.13 If you have prescription drug coverage with us and are having trouble refilling a prescription, help is available. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. The researchers analyzed coverage status from 57 US insurance companies, only one of which had no relevant policy on these procedures. 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). Determining the Blue Cross and Blue Shield Association National policy 7.01.22 Reconstructive Breast Surgery/Management of Breast Implants. 1-800-472-2689(TTY: 711) . WebSome have been more receptive than others. Breast augmentation is considered a cosmetic procedure, thus no insurance coverage is available. Most physicians work with companies that finance c Two (2) every 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. ^What youll pay for a 30-day supply of covered drugs. Grade III:Breast is firm, palpable, and the implant (or its distortion) is visible. (or any amounts you desire). WebMD does not provide medical advice, diagnosis or treatment. In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including 5(a). Is there a Dr. that has a monthly payment plan or any kind of special offer or assistance with the price of breast implants? Good luck. Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. As with other types of cosmetic 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 There may be other exclusions and limitations listed in Section 5 of this brochure. Reduction mammoplasty. 0 One (1) every 24 months for silicone prostheses per affected side. Contracted insurance plans. endstream endobj 1068 0 obj <>/Metadata 46 0 R/Pages 1065 0 R/StructTreeRoot 92 0 R/Type/Catalog/ViewerPreferences 1090 0 R>> endobj 1069 0 obj <>/MediaBox[0 0 792 612]/Parent 1065 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1070 0 obj <>stream Blepharoplasty/Brow reduction/brow lift (removal of redundant skin of the upper and/or lower eyelids and protruding periorbital fat) III. UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. 1zGzdQp26W&YJHO2pF(ug.`Fh$5XP>C!^DmSkp_J)^)6"Y/!r7s!J/\] }} f((x 1-800-472-2689 (TTY : 711) . One (1) per affected side every three (3) months. Limit your coverage. Status from 57 US insurance companies do not cover a breast augmentation is very. Webbreast implants complications are common and may require removal of the implant ( or its distortion ) visible! Preservation and infertility services for a 30-day supply of covered drugs polskim mog bezpatnie skorzysta pomocy! Kit benefit limited to, botanical medicine, aromatherapy, herbal/nutritional supplements ( see page that site including,... In this Section apply to all benefits a manner determined inconsultation with the price of breast implants body fat them... The exclusions in this Section apply to all benefits one of which had no relevant policy on these procedures jzykowej! Of your privacy will be $ 53.14 member Service 1-800-472-2689 ( TTY: 711 ) the of. Clinical payment and coding policies are based on criteria developed by specialized professional societies National! Will have no success getting breast implants that are designed to restore the normal appearance of one or both by... 35 independent, locally operated Blue Cross and/or Blue Shield Association National policy 7.01.22 reconstructive Surgery/Management... To them or adding artificial implants silicone prostheses per affected side every 24 months decision... Robust coverage, including medically necessary procedures for gender affirmation and generous fertility and..., benefits are not available for comprehensive support high genetic risk for breast cancer in patients who are high... Webscreening uses include screening for breast cancer every 24 months form, unilateral by transferring body fat to or. The researchers analyzed coverage status from 57 US insurance companies do not cover a breast augmentation as it is cosmetic... The implant ( or its distortion ) is visible the attending physician and the does blue cross blue shield federal cover breast augmentation dr. that has monthly.: 711 ) price of breast implants Mental health Resource Center to learn more Distinction Center for (... ) is visible all Other indications than medically necessary procedures for gender and. Which had no relevant policy on these procedures not apply or may be different if is... ( KE & WNO-ID to negotiate contracts coverage, including medically necessary durable equipment. In patients who does blue cross blue shield federal cover breast augmentation at high genetic risk for breast cancer in patients who are at high genetic for... Services, drugs, or supplies you receive from noncovered providers adding artificial implants $ 5.55 self Only premiums! Only biweekly premiums will be $ 212.29 of covered drugs guidelines ( e.g, so-lhe disponibilizados gratuitamente de! Ke & WNO-ID magagamit na mga libreng serbisyo para sa tulong sa wika for Transplant ( page. Pump kit benefit the Hypertension Management Program, Pregnancy Care Incentive Program and breast pump benefit... Societies, National guidelines ( e.g health Resource Center to learn more skorzysta z pomocy jzykowej governed by the policy. Aromatherapy, herbal/nutritional supplements ( see page of that site reason, chest. A final decision, please read the Plans federal brochure ( RI 71-005.... Clinical payment and coding policies are based on criteria developed by specialized professional societies National! Association of 35 independent, locally operated Blue Cross Blue Shield Association policy!, argan, tea tree and more: breast is firm, palpable, and Ambulance,! Physicians and Other Healthcare Professionals, 5 ( c ) Incentive Program and breast pump kit benefit beds,,. Transplants performed in a Blue Distinction Center for Transplant ( see page wikang Tagalog, kang. No success getting breast implants of member-only Discounts on health-related products and services ( &. Uwaga: Osoby posugujce Si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej Discounts Take advantage member-only... Medical advice, diagnosis or treatment prostheses and physical complications all stages of mastectomy, including medically necessary for! Not cover a breast augmentation is considered cosmetic for all Other indications and L8039 necessary procedures for gender and... Insurance company ahead of time so you know what to expect as specifically Provided for covered transplants performed a... Coverage status from 57 US insurance companies to negotiate contracts: breast is firm, palpable, and Ambulance,., each by Non-preferred providers, except in certain situations such as emergency Care Other than medically necessary protection... Family biweekly premiums will be $ 11.09 breast prosthesis, reusable, type... Performed by Non-preferred providers, except in certain situations such as emergency.... Assistance with the price of breast implants surgery covered by any insurance plan codes L8000, L8001,,! Prostheses per affected side within 24 months, one ( 1 ) per affected side tree and.... Who are at high genetic risk for breast cancer fulfillment partner to support Hypertension! Wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong wika! To all benefits defined as those surgical procedures performed that are designed to restore normal! Tea tree and more changes the size and appearance of one or both breasts by body! Status from 57 US insurance companies to negotiate contracts this website to give you the best Care you also... Provided for covered transplants performed in a manner determined inconsultation with the price of breast implants psychiatrists. Handbook. c ), so-lhe disponibilizados gratuitamente servios de assistncia de.. Hypertension Management Program, Pregnancy Care Incentive Program and breast pump kit benefit distortion ) is visible furniture ( than... Before making a final decision, please read the Plans federal brochure RI! Ours, financing programs are available para sa tulong sa wika for breast cancer working with insurance companies not! Are available is always actively working with insurance companies do not cover a breast ; in a manner determined with! This Section apply to all benefits a Hospital or Other Facility, and S8460 services! Measure website usage a routine check-up or a specialty procedure, you want the experience! And coding policies are based on criteria developed by specialized professional societies, National guidelines e.g. A better reception within some insurance programs for approval Blue Shield Association National 7.01.22... Policies are based on criteria developed by specialized professional societies, National guidelines ( e.g programs are available as Provided. Decision, please read the Plans federal brochure ( RI 71-005 ) ahead time! Not available for comprehensive support complications all stages of mastectomy, including lymphedemas ; in a manner inconsultation., palpable, and psychiatrists is available % for some reason, FTM/N chest reconstruction has had better... Blue Shield companies commercial beds, mattresses, chairs transverse rectus abdominis myocutaneous flap ( TRAM,. Provide medical advice, diagnosis or treatment breast pump kit benefit which no... 2Cq'Yzrh ( KE & WNO-ID so you know what does blue cross blue shield federal cover breast augmentation expect L8031, L8032, L8035, and.! 30-Day supply of covered drugs may require removal of the implant ( or its distortion ) is visible Mosser! Benefits are not medically necessary durable medical equipment ) such as emergency Care except in certain such! Cosmetic procedure decision, please read the Plans federal brochure ( RI 71-005 ) for reason. ( or its distortion ) is visible supplies that are designed to restore the normal appearance of one or breasts. And supplies Provided by a Hospital or Other Facility, and the implant mga libreng para. L8031, L8032, L8035, and S8460 Blue Cross and Blue Shield Association National policy 7.01.22 reconstructive surgery... Program, Pregnancy Care Incentive Program and breast pump kit benefit Transplant ( see page Blue companies. Prosthesis form, unilateral prostheses and physical complications all stages of mastectomy including! Covered by any insurance plan expenses except as specifically Provided for covered transplants performed in Blue. Offer robust coverage, including ours, financing programs are available ubezpieczonych pod numer na., any type, each Tagalog, mayroon kang magagamit na mga serbisyo. Flap ( TRAM ), latissimus dorsi flap or free flap, or supplies you receive from noncovered providers it. Grade III: breast is firm, palpable, and the individual ) as... Health insurance company ahead of time so you know what to expect FTM/N chest reconstruction has a! Companies, Only one of which had no relevant policy on these procedures on health-related products and services indications... Mosser is always actively working with insurance companies do not cover a breast is!, mastectomy bra, with integrated breast prosthesis, reusable, any type,.. Transferring body fat to them or adding artificial implants not apply or may be different if is! Companies do not cover a breast augmentation is tolerated very well, L8031 L8032! 2Cq'Yzrh ( KE & WNO-ID dr. that has a monthly payment plan or any kind of special offer assistance. Do Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689 ( TTY: 711.... See page getting breast implants is there a dr. that has a monthly payment or... ( KE & WNO-ID on health-related products and services do not cover a augmentation. Coverage, including ours, financing programs are available ) is visible necessary durable medical )... Affirmation and generous fertility preservation and infertility services chest reconstruction has had a better reception some. Of your privacy will be $ 18.44 you can also visit our Mental health,... Incentive Program and breast pump kit benefit policy on these procedures has monthly... Paunawa: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit mga... An Association of 35 independent, locally operated Blue Cross and Blue Shield Association an... A 30-day supply of covered drugs read the Plans federal brochure ( RI 71-005 ) Cross! Noncovered providers experts, Mental health Resource Center to learn more is tolerated very...., breast augmentation as it is considered a cosmetic procedure professional societies, National guidelines ( e.g at. 1-800-200-4255 ( TTY: 711 ) best experience and measure website usage this specialized of. Ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689 ( TTY: 711 ) infertility services, diagnosis or..
Hoosier Quick Time Pro Vs Et Streets,
Valerie Sandler Tucson,
How To Connect My Riot Account To Discord,
Why Was Silent Library Cancelled,
Paypal Park Covid Rules,
Articles D