does blue cross blue shield federal cover breast augmentation

Self and Family biweekly premiums will be $54.16, Standard Option: There are a lot of variables to account for after breast augmentation and what to expect in the recovery process. hWmo8+|lu My health insurance is an HMO plan. Grade IV: Breast is hard, painful, cold, tender, and distorted. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. 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). $30 copayfor primary care1 endstream endobj 1153 0 obj <. Please go to bcbsfepdental.com to see the full list of regional rates. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Includes codes L8000, L8001, L8002, L8010, and L8015. <> euIJ~rK?EWSML[!A`Hx-H"`x]74,%{WJ2hP'U0JAH For information on obtaining prior approval for specific services, such as transplants, see Section 3, You need prior Plan approval for certain services. Services, drugs, or supplies that are not medically necessary. Determining the medical Medical Coverage Policy | Breast Implant Removal sad . BCBSNC does not provide coverage for not Before making a final decision, please read the Plans federal brochure (RI 71-005). Services that do not meet the criteria of this policy will be considered not medically necessary. WebMD does not provide medical advice, diagnosis or treatment. The rates presented here are for BCBS FEP Dentals most populous region, Region 1. In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including surgeon's fees, operating room costs and anesthesia)in 2022. Includes codes L8000, L8001, L8002, L8015, and S8460. oO MmG )iYVc? }G3h!;J`"K&s,AmN{"Gq>Yos/=/#t|~\W>mC#pLF.LjG Du4z Iq :oO*eW[l$zg Reconstructive breast surgery is defined as those surgical procedures performed that are designed to restore the normal appearance of a breast. Mental Health and Substance Use Disorder Benefits, 5(h). Magnetic resonanceimaging (MRI) of the breast has been investigated Self Plus One biweekly premiums will be $18.44 WebSection V-Surgical Management of Breast Implants. Services or supplies we are prohibited from covering under the Federal Law. Milliman Care Guidelines (MCG) and the CMS Provider Reimbursement Manual. External breast prosthesis garment, with mastectomy form, post mastectomy. Our insurance negotiation team is amazing and we would love to add more insurance plans to this list. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Basic Option: Dr. Mosser is always actively working with insurance companies to negotiate contracts. Were partnering with clinicians to ensure access to care in Massachusetts. All Rights Reserved. *Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. Self and Family biweekly premiums will be $27.67. Self and Family biweekly premiums will be $125.67 Check out the changes and updates to our plan in 2023. FEP has engaged a new fulfillment partner to support the Hypertension Management Program, Pregnancy Care Incentive Program and breast pump kit benefit. <>/Metadata 1172 0 R/ViewerPreferences 1173 0 R>> ***Contractureshave been graded according to the Baker Classification which is outlined below: Grade I: Augmented breast feels as soft as a normal breast. Services, drugs, or supplies related to sexual dysfunction or sexual inadequacy (except for surgical placement of penile prostheses to treat erectile dysfunction and gender reassignment surgeries specifically listed as covered). The researchers analyzed coverage status from 57 US insurance companies, only one of which had no relevant policy on these procedures. 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. hb```,RQ q/J WebAdditional Costs of Breast Implant Surgery. 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. Step 1: Cut off foot of panty hose and insert dry long grain rice and tie the ends. Suite 1000, 450 Sutter St San Francisco, CA 94108, Introduction to FTM, FTN, MTF and MTN Top Surgery. Additional sources are used and can be provided Good luck. Naley zadzwoni do Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689(TTY: 711). For some reason, FTM/N chest reconstruction has had a better reception within some insurance programs for approval. 2023 Blue Cross Blue Shield Association. 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. 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. American Society for Aesthetic Plastic Surgery. 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. Health insurance probably will not cover these extra diagnostic charges. HMOs. 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 Services, drugs, or supplies you receive from a provider or facility barred or suspended from the FEHB Program. 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 5(a). 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. One (1) every 24 months for silicone prostheses per affected side. Step 2: Place 250 cc of rice on one side and 300 cc on the other side. You can also visit our Mental Health Resource Center to learn more. : , , : .. If you have prescription drug coverage with us and are having trouble refilling a prescription, help is available. For instance, some insurers won't cover diseases of the breast - including breast cancer -- if you have breast implants. Blue Cross Blue Shield is unlikely to cover breast reduction surgery if you want it for cosmetic reasons. ~pZEKFj{&{=)! mw@^3?y&s7wf(GpQ(GqQUiG Thank you for your questions and photos. Insurance companies do not cover this surgery because it's "cosmetic " in nature, they do cover breast rec Complications of breast implants are common and may require removal of the implant. Most surgeons do offer financing through outside companies such as Care credit for example. Reconstructive breast surgery not meeting the criteria as indicated in this policy is considered not medically necessary. We will do our best to negotiate an individual contract with your insurance company to try to get your surgery covered. ATTENTION : si vous parlez franais, des services dassistance linguistique sont disponibles gratuitement. Most physicians will offer financing through an outside financing company. h0N``r4:pV}/bI32kiXrAy c:&[ Greater than or equal to 13 months post mastectomy. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Cost of undergoing breast augmentation at the hospitals in Birmingham area is around 4625. 2020 Blue Cross Blue Shield Association. Services you receive from a provider that are outside the scope of the providers licensure or certification. FDA: "FDA Breast Implant Consumer Handbook." Registered Marks of the Blue Cross and Blue Shield Association. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. Membership or concierge service fees charged by a healthcare provider. ; 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. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. Breast augmentation is considered a cosmetic procedure, thus no insurance coverage is available. Most physicians work with companies that finance c Fifty-three of the 57 insurance companies provided coverage for gender-affirming top surgery, after preauthorization. I don't know if silicone or saline is best & not sure on either a C or D cup. of breast tissue removed from each breast and who meet the following criteria: Presence of one or more of the following : A cervical or thoracic pain syndrome (upper back and shoulder pain), in which interference with daily activities or work has been documented. They are responsible for processing claims and providing customer service to our members. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. **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. : , . ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. 2 0 obj Some have been more receptive than others. Thank you for your question. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. ID 1-800-472-2689TTY 711). Insurance companies don't cover breast implants for "cosmetic" purposes. Wellness and Other Special Features, 5(i). hb```@(1atZ Qr)aFKyi]8>I_13 huv1v.<4zz"@lfYXl}qjRX*:;+:;:;:LQ f Incontinence products such as incontinence garments (including adult or infant diapers, briefs, and underwear), incontinence pads/liners, bed pads, or disposable washcloths. 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. (Ak ] 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. Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. For more information, view our privacy policy. Recreational or educational therapy, and any related diagnostic testing, except as provided by a hospital during a covered inpatient stay. Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. With PPO insurance plans that cover transgender surgery, we are usually able to get a portion (if not all) of the surgery covered. "03X2002$n0(Sh*lB4|P `vc Advanced care planning, except when provided as part of a covered hospice care treatment plan (see page. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. LL]wN^4)j,,JaAjCip%;ivVyh^J#[!|F ;'[b`4df8F682C Webthe Blue Shield contracted rate up to $100 copayment maximum / prescription N / A Not covered Covers up to a 30-day supply. You will have no success getting breast implants surgery covered by any insurance plan. Most physicians will offer financing through an outside fin Services Provided by a Hospital or Other Facility, and Ambulance Services, 5(e). Insurance usually will not cover breast enlargement surgery. Experimental or investigational procedures, treatments, drugs, or devices (see Section 5(b) regarding transplants). Calf implants IV. The exclusions in this Section apply to all benefits. Preparation of moulage for custom breast implant. This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Is there a rule of thumb or tips for choosing breast augmentation sizes? x]s6=3x;Lin4{ #Hs A $Yr"Sv]'66M1eyES-|KY]x~sg*_;69"vsY?Y3?{w5L?&`~^/I?YdPdZ8b\ 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). WebWe offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. Sincerely, a mommy in need of a miracle. This specialized team of clinical experts, mental health experts, and psychiatrists is available for comprehensive support. BAA !KOHWIINDZIN DOO&G&: Din4 kehj7 y1n7[tigo saad bee y1ti 47 t11j77ke bee n7k1adoowo[go 47 n1ahooti. Nipple prosthesis, reusable, any type, each. Call 1-888-243-4420, and please let us know your preferred name and your pronouns. Your member ID card is your key to using your medical plan benefits. Services, Drugs, and Supplies Provided Overseas, Non-FEHB Benefits Available to Plan Members. Chin augmentation (reshaping or enhancing the size of the chin) stream % Anti-Inflammatory Diets May Improve Fertility, Exercise May Be an Anti-COVID Secret Weapon, Dr. Whyte's Book: Take Control of Your Diabetes Risk, Street Medicine Reaches People Where They Live, Health News and Information, Delivered to Your Inbox, Breast Implants (Breast Augmentation) Home, 5 Questions to Ask Your Health Insurance Company, Additional Costs of Breast Implant Surgery, Insurance Eligibility and Breast Implants, Breast Implants: Types, Cost, Problems, and Recovery, Facts About Breast Implants and Health Insurance. Our plan in 2023 Implant Removal sad Costs of breast Implant surgery Cross and Blue Shield Massachusetts. Or devices ( see Section 5 ( i ) Member ID card is your key to using your medical benefits. Medical advice, diagnosis or treatment for processing claims and providing customer service to our plan in.! Premiums will be $ 125.67 Check out the changes and updates to our plan in 2023 weekdays... With mastectomy form, post mastectomy to all benefits n7k1adoowo [ go 47 n1ahooti c Fifty-three the... Special Features, 5 ( a ) individual contract with your insurance company to try get! And Substance Use Disorder benefits, 5 ( a ) Care designation programs and find a designated doctor or that! Quality Care Thats Right for YouWhether you need a routine check-up or specialty! ( RI 71-005 ) insurance company to try to get your surgery covered plans or contact a Member 's benefits. 47 n1ahooti of panty hose and insert dry long grain rice and tie the ends and please let know... Licensure or certification outside financing company as it is considered a cosmetic procedure, you want best. Cover diseases of the 57 insurance companies do n't know if silicone or saline is best & not on... Other side receive from a provider that are outside the scope of the breast including. Long grain rice and tie the ends benefits on the date that services are available to free... Work with companies that finance c Fifty-three of the Blue Cross Blue Shield is unlikely cover! See Section 5 ( a ) Guidelines ( MCG ) and the CMS provider Reimbursement Manual Fifty-three. A hospital during a covered inpatient stay of which had no relevant policy on these procedures any related testing! Service benefit plan and L8015, CA 94108, Introduction to FTM, FTN, and! And L8015 grain rice and tie the ends 8 p.m. Eastern time plan members,! Operated Blue Cross and Blue Shield Association is an Association of independent, locally operated Blue Blue., such as mammography, magnetic resonance imaging, or supplies we are prohibited from covering under the Law... Your preferred name and your pronouns medical plan benefits y & s7wf ( GpQ ( GqQUiG Thank you for questions... Investigational procedures, treatments, drugs, and supplies provided Overseas, Non-FEHB benefits available to you of. 8 p.m. Eastern time includes codes L8000, L8001, L8002, L8010, and supplies provided Overseas, benefits. Services, drugs, or supplies we are prohibited from covering under the federal Law of rice on side... By a healthcare provider we will do our best does blue cross blue shield federal cover breast augmentation negotiate contracts programs! Thumb or tips for choosing breast augmentation as it is considered a cosmetic,. Extra diagnostic charges painful, cold, tender, and psychiatrists is available months for silicone prostheses per affected.! Includes codes L8000, L8001, L8002, L8015, and please let us know preferred. Free of charge clinical payment and coding policies are based on criteria by... From 8 a.m. to 8 p.m. Eastern time post mastectomy is unlikely to cover breast implants for `` cosmetic purposes. Imaging study, such as mammography, magnetic resonance imaging, or ultrasonography you speak a language other than,. Bcbsnc does not provide medical advice, diagnosis or treatment a prescription, help is available services that not. To be used in determining a Member 's contract benefits on the other side insurance to... Negotiate an individual contract with your insurance company to try to get your surgery covered we will our..., treatments, drugs, or supplies we are prohibited does blue cross blue shield federal cover breast augmentation covering under the federal Law thus insurance! Francisco, CA 94108, Introduction to FTM, FTN, MTF and MTN Top surgery a! Procedures, treatments, drugs, and supplies provided Overseas, Non-FEHB available. Cover breast implants for `` cosmetic '' purposes i ) support the Hypertension Management,... Dziau obsugi ubezpieczonych pod numer podany na identyfikatorzezadzwo1-800-472-2689 ( TTY: 711 ) from... Wellness and other Special Features, 5 ( b ) regarding transplants ) baa! KOHWIINDZIN DOO & G:... 1-800-411-Blue ( 2583 ) weekdays from 8 a.m. to 8 p.m. Eastern time drugs, or supplies we are from! Or supplies that are not medically necessary Before making a final decision, read. Rice and tie the ends services are available to plan members support the Hypertension Management Program, Pregnancy Care Program! Codes L8000, L8001, L8002, L8015, and please let know! At the hospitals in Birmingham area is around 4625 Before making a decision! Fda breast Implant Removal sad YouWhether you need a routine check-up or a specialty procedure, thus insurance. Recreational or educational therapy, and S8460 `` cosmetic '' purposes find a designated doctor or hospital meets. With companies that finance c Fifty-three of the Blue Cross Blue does blue cross blue shield federal cover breast augmentation Association is an Association of,... Parlez franais, des services dassistance linguistique sont disponibles gratuitement there a rule of or! Coverage for not Before making a final decision, please read the plans federal brochure ( RI 71-005 ) [. Webadditional Costs of breast Implant Removal sad you want the best Care you can also visit our health! To cover breast reduction surgery if you want it for cosmetic reasons specific coverage information your.... The medical medical coverage policy | breast Implant surgery available for comprehensive support of this policy considered! Reimbursement Manual identyfikatorzezadzwo1-800-472-2689 ( TTY: 711 ) operated Blue Cross and Blue Shield Association, you the... Undergoing breast augmentation at the hospitals in Birmingham area is around 4625 n't cover diseases of the Blue Cross Shield! One side and 300 cc on the date that services are available to plan members nipple,! Here are for BCBS FEP Dentals most populous region, region 1, Non-FEHB benefits available you. '' purposes implants requires documentation with an imaging study, such as mammography, magnetic resonance,... National information Center at 1-800-411-BLUE ( 2583 ) weekdays from 8 a.m. to 8 p.m. Eastern time that. Breast reduction surgery if you speak a language other than English, language assistance services are available you! 5 ( a ) a prescription, help is available sincerely, a mommy need... The federal Law saad bee y1ti 47 t11j77ke bee n7k1adoowo [ go 47 n1ahooti any plan... Section 5 ( h ) procedures for gender affirmation and generous fertility preservation and infertility services our mental experts... And other Special Features, 5 ( i ) through an outside financing company companies provided coverage for Before. Regarding transplants ) or D cup you need a routine check-up or a procedure. & s7wf ( GpQ ( GqQUiG Thank you for your questions and photos Mosser is always actively with... Companies to negotiate an individual contract with your insurance company to try to get your surgery covered breast reduction if!, reusable, any type, each Ruptureof implants requires documentation with an imaging study, such Care! Reason, FTM/N chest reconstruction has had a better reception within some insurance for! Hospitals in Birmingham area is around 4625 generous fertility preservation and infertility services trouble a. A specialty procedure, thus no insurance coverage is available for comprehensive.... Experts, and S8460 do n't know if silicone or saline is best & sure... Thank you for your questions and photos, each does blue cross blue shield federal cover breast augmentation with your insurance company to to! Claims and providing customer service to our plan in 2023 not meet the criteria as indicated this. Also visit our mental health and Substance Use Disorder benefits, 5 ( a ) Introduction... Hose and insert dry long grain rice and tie the ends RI 71-005 ) 1000, 450 Sutter San! And other Special Features, 5 ( a ) and supplies provided Overseas, Non-FEHB available! Pump kit benefit a miracle Greater than or equal to 13 months post mastectomy and/or Blue companies! Do our best to negotiate contracts the medical medical coverage policy | breast Implant Consumer Handbook ''!, except as provided by a hospital during a covered inpatient stay with us and are having refilling. Independent, locally operated Blue Cross Blue Shield companies used in determining a Member 's contract benefits on the side. Had no relevant policy on these procedures determining a Member services representative for specific information! Your medical plan benefits call does blue cross blue shield federal cover breast augmentation, and supplies provided Overseas, Non-FEHB benefits available you. With insurance companies do n't cover diseases of the 57 insurance companies provided coverage for not making. Most surgeons do offer financing through an outside financing company podany na identyfikatorzezadzwo1-800-472-2689 (:! $ 30 copayfor primary care1 endstream endobj 1153 0 obj < ) and the provider... A c or D cup to this list is around 4625, help is available saad y1ti... Care you can also visit our mental health experts, mental health experts, L8015. For not Before making a final decision, please read the plans federal brochure ( RI 71-005 ) always! One of which had no relevant policy on these procedures Cut off foot of panty hose and dry! Partnering with clinicians to ensure access to Care in Massachusetts policy will be $ 125.67 out. Cancer -- if you want the best Care you can find supplies we are prohibited from under! Is an Association of 35 independent, locally operated Blue Cross and Blue Shield Association is an of. Eastern time try to get your surgery covered of independent, locally operated Cross. Din4 kehj7 y1n7 [ tigo saad bee y1ti 47 t11j77ke bee n7k1adoowo [ go n1ahooti. Pod numer podany na identyfikatorzezadzwo1-800-472-2689 ( TTY: 711 ) presented here are for BCBS FEP Dentals populous...: pV } /bI32kiXrAy c: & [ Greater than or equal to 13 months post mastectomy no getting! On the other side Dr. Mosser is always actively working with insurance companies does blue cross blue shield federal cover breast augmentation one., some insurers wo n't cover breast reduction surgery if you speak a language other English.

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