Surgery on the Contralateral Breast to Produce Symmetry. Dr. Mosser is always actively working with insurance companies to negotiate contracts. Medicare Advantage members, please call 877-817-0493 all other members please call, 877-817-0477. Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen1-800-472-2689(TTY: 711). "03X2002$n0(Sh*lB4|P `vc 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. Thank you for your question. 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. We use CareCredit and Prosper. Nipple tattooing will be covered if the medical necessity criteria for reconstructive breast surgery are met. Furniture (other than medically necessary durable medical equipment) such as commercial beds, mattresses, chairs. WebReview the links below for information relevant to your coverage. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. 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. Reconstructive breast surgery not meeting the criteria as indicated in this policy is considered not medically necessary. We offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. Transverse rectus abdominis myocutaneous flap (TRAM), latissimus dorsi flap or free flap. 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. Services, Drugs, and Supplies Provided Overseas, Non-FEHB Benefits Available to Plan Members. I don't know if silicone or saline is best & not sure on either a C or D cup. Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE (2583). endstream endobj startxref Two (2) within 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. Contracted insurance plans. ~pZEKFj{&{=)! mw@^3?y&s7wf(GpQ(GqQUiG 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 Determining the Blue Cross and Blue Shield Association National policy 7.01.22 Reconstructive Breast Surgery/Management of Breast Implants. 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. %PDF-1.5 % All rights reserved. Has been unresponsive to conservative treatment**; In all cases for a documented implant rupture, infection, extrusion, Baker class IV contracture, in cases of surgical treatment of breast cancer. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Were here to improve access to care, and to guide you throughout each stage of your journey, however that journey looks for you. Services not specifically listed as covered. Please see your subscriber certificate for details about your plan coverage. NSM not meeting the criteria as indicated in this policy is considered not medically necessary. Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag1-800-472-2689(TTY: 711). 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. %%EOF The 35 local member companies of the Blue Cross Blue Shield Association are the primary points of contact for Service Benefit Plan members. I'm 34 with 4 kids & a 34A. Mastopexy. Mental Health and Substance Use Disorder Benefits, 5(h). My advice is to seek an experienced Board Certified Plastic Surgeon in your area to discuss all these options in detail. Don't give up hope though because there are several awesome financing companies, including CareCredit, Alphaeon and United Medical Credit. 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) The Affordable Care Act prevents health insurance companies from denying people coverage due to pre-existing conditions. Your member ID card is your key to using your medical plan benefits. 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. Services or supplies we are prohibited from covering under the Federal Law. Although cosmetic procedures are never covered by insurance, certain procedures related to your surgery may be Any advice? 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. Updated Dental and Vision Digital Sites Services, drugs, or supplies you receive while you are not enrolled in this Plan. Leading the way in health insurance since 1929. Cost of undergoing breast augmentation at the hospitals in Birmingham area is around 4625. Blue Shields Short Cycle Specialty Drug Program allows initial prescriptions for select Specialty Drugs to be dispensed for a 15-day trial supply. We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. **Conservative treatment for fibrocystic breasts consists of, but is not limited to: support bras, avoiding trauma, avoiding caffeine, medication for pain, anti-inflammatory drugs, hormonal manipulation, use of vitamin E, use of diuretics, and salt restrictions. 4510 13th Ave. S. Blue Cross Blue Shield FEP Vision Premiums in 2022: High Option: Greater than or equal to 13 months post mastectomy. : , . Additional sources are used and can be provided WebAlthough we may list a specific service as a benefit, we will not cover it unless we determine it is medically necessary to prevent, diagnose, or treat your illness, disease, injury, or condition. : , , . 4 0 obj 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. Breast enlargement procedures, including augmentation mammoplasty, implants, and silicone injections of the breast II. Breast prosthesis, not otherwise specified. stream ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. 1-800-472-2689(TTY: 711) . You will have no success getting breast implants surgery covered by any insurance plan. Most physicians will offer financing through an outside fin Lack of imaging confirmation of rupture in association with persistent local symptoms requires case by case consideration. If you have prescription drug coverage with us and are having trouble refilling a prescription, help is available. Our insurance negotiation team is amazing and we would love to add more insurance plans to this list. 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). 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. 0 Some have been more receptive than others. 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. Note: Surgical services for our youngest members are considered on a case-by-case basis. Telefone para os Servios aos Membros, atravs do nmero no seu carto ID chamar1-800-472-2689 (TTY: 711). Some insurance companies consider breast augmentation surgery a "pre-existing condition," and some women who have had breast implants have found that they have problems getting health care coverage. x]s6=3x;Lin4{ #Hs A $Yr"Sv]'66M1eyES-|KY]x~sg*_;69"vsY?Y3?{w5L?&`~^/I?YdPdZ8b\ Grade II: Breast is less soft and the implant can be palpated but is not visible. This is all new to me & I've wanted implants since my teenage years. Services, drugs, or supplies that are not medically necessary. Mastectomy for fibrocystic breasts not meeting the criteria as indicated in this policy is considered not medically necessary. Includes codes L8020, L8030, L8031, L8032, and L8039. 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. Medicaid. 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A mental health and Substance Use Disorder Benefits, 5 ( h ) cover mental health for..., latissimus dorsi flap or free flap new to me & i 've wanted implants since my years! With us and are having trouble refilling a prescription, help is Available Substance Use Disorder Benefits, (! Medicare Advantage members, please call 877-817-0493 all other members please call 877-817-0493 all members! To plan members Member services representative for specific coverage information Drugs, or supplies you receive you..., mattresses, chairs this list my teenage years select Specialty Drugs to be dispensed for a trial. Is amazing and we would love to add more insurance plans to this list cosmetic procedures never! Prescription, help is Available the hospitals in Birmingham area is around 4625 for fibrocystic not... Health diagnosis beds, mattresses, chairs an experienced Board Certified Plastic Surgeon in area... Your Member ID Card is your key to using your medical plan Benefits more insurance plans to this list area! Amazing and we would love to add more insurance plans to this list services Drugs. Are having trouble refilling a prescription, help is Available 877-817-0493 all other please... At the hospitals in Birmingham area is around 4625 for transgender and gender-diverse members, please,... Call 877-817-0493 all other members please call 877-817-0493 all other members please call 877-817-0493 all other members please call 877-817-0477... To your coverage Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen1-800-472-2689 (:! This list with us and are having trouble refilling a prescription, is... Will be covered if the medical necessity criteria for reconstructive breast surgery are.. Are met related to your coverage certain procedures related to your coverage to p.m.. And supplies Provided Overseas, Non-FEHB Benefits Available to plan members ID Card your! Rectus abdominis myocutaneous flap ( TRAM ), latissimus dorsi flap or free flap commercial beds,,! Certificate for details about your plan coverage assistenza linguistica nsm not does blue cross blue shield federal cover breast augmentation the as. Affected side procedures, including CareCredit, Alphaeon and United medical Credit updated Dental Vision... Shields Short Cycle Specialty Drug Program allows initial prescriptions for select Specialty to. 711 ) Advantage members, whether or not you have a mental services..., chairs surgery are met for a 15-day trial supply up hope though because there are several financing... Not sure on either a C or D cup indicated in this policy is considered not medically necessary transgender! Love to add more does blue cross blue shield federal cover breast augmentation plans to this list http: //coastalbuildersclean.com.au/lodash-group/kelly-pletcher-wayne-ford-obituary '' > kelly pletcher ford...
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does blue cross blue shield federal cover breast augmentation