Hello.Thank you for your questions. Adhesive skin support attachment for use with external breast prosthesis, each. Abdominoplasty and Lipectomy are considered cosmetic and not medically necessary for all applications. 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. 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. Nothing for covered preventive screenings, immunizations and services, In-network care only, except in certain situations like emergency care. In a documented implant rupture for those individuals who had originally undergone breast implantation for reconstructive purposes; In cases of infection, extrusion, Baker class IV contracture, or surgical treatment of breast cancer. Although cosmetic procedures are never covered by insurance, certain procedures related to your surgery may be We have Member Service associates who can review your benefits and costs, and help you find a doctor who fits your needs. 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. Is there a rule of thumb or tips for choosing breast augmentation sizes? 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. 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. 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. Refer to Table Attachment for a chart to assist with medical necessity determination for implant removal. Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE (2583). Basic 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. All rights reserved. BCBS FEP Dental has also released a suite of new features for its mobile app, which will allow members to view benefit, coverage and claim information, and access their ID card, all in one location. 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. Before making a final decision, please read the Plans federal brochure (RI 71-005). 4 0 obj
Suite 1000, 450 Sutter St San Francisco, CA 94108, Introduction to FTM, FTN, MTF and MTN Top Surgery. 2 0 obj
* Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. 1-800-472-2689(TTY: 711). Advanced care planning, except when provided as part of a covered hospice care treatment plan (see page. 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. Having breast implants may also affect your insurance rates later on. There may be other exclusions and limitations listed in Section 5 of this brochure. We will do our best to negotiate an individual contract with your insurance company to try to get your surgery covered. You might check out their web sites for specific information. 1-800-472-2689(TTY: 711) . FEP has engaged a new fulfillment partner to support the Hypertension Management Program, Pregnancy Care Incentive Program and breast pump kit benefit. HMOs. Fifty-three of the 57 insurance companies provided coverage for gender-affirming top surgery, after preauthorization. x]s6=3x;Lin4{
#Hs A $Yr"Sv]'66M1eyES-|KY]x~sg*_;69"vsY?Y3?{w5L?&`~^/I?YdPdZ8b\ You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. Includes codes L8030, L8031, L8032, L8035, and L8039. Fargo, N.D., 58121. Check our F.A.Q. -L . WASHINGTON, Sep. 30, 2021 Today the Blue Cross and Blue Shield (BCBS) Government-wide Service Benefit Plan, also known as the Federal Employee Program (FEP), announced 2022 benefits available to eligible participants in the Federal Employees Health Benefits (FEHB) Program and the Federal Employees Dental and Vision Insurance Program (FEDVIP). ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. )jiH9A ,-&_[7`!PWg GUb971IXsH"$I= $QDG! The researchers analyzed coverage status from 57 US insurance companies, only one of which had no relevant policy on these procedures. For more information, view our privacy policy. Self Only biweekly premiums will be $18.05 , 1-800-472-2689(: 711). Milliman Care Guidelines (MCG) and the CMS Provider Reimbursement Manual. Two companies provided coverage on a case-by case basis; one I have blue cross blue shield with blue local. Self Plus One biweekly premiums will be $11.09 ATENO: Se fala portugus, so-lhe disponibilizados gratuitamente servios de assistncia de idiomas. For members whose gender identity differs from assigned sex at birth, we traditionally cover:*. All rights reserved. If you are facing this surgery, take some comfort in knowing that federal and state laws require Services, drugs, or supplies you receive without charge while in active military service. Call 1-800-200-4255(TTY: 711). HC qgV
Lumpectomy is the removal of the breast tumor and surrounding tissue. 1089 0 obj
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Determining the Blue Cross and Blue Shield Association National policy 7.01.22 Reconstructive Breast Surgery/Management of Breast Implants. Grade IV: Breast is hard, painful, cold, tender, and distorted. In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including Llame al nmero de Servicio al Cliente que figura en su tarjeta de identificacin llamada1-800-472-2689 (TTY: 711). They are responsible for processing claims and providing customer service to our members. ATTENTION : si vous parlez franais, des services dassistance linguistique sont disponibles gratuitement. LU . Please see your subscriber certificate for details about your plan coverage. Services, drugs, or supplies you receive for cosmetic purposes. Blue Cross and Blue Shield of North Carolina will not assign specific length of stay for patients having a mastectomy. 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. ! Prescriptions, services or supplies ordered, performed, or furnished by you or your immediate relatives or household members, such as spouse, parents, children, brothers, or sisters by blood, marriage, or adoption. PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. Self Only biweekly premiums will be $3.56 Services, drugs, or supplies you receive from a provider or facility barred or suspended from the FEHB Program. New Enhanced Benefit Programs No-indicates the removal would be considered not medically necessary. Personal comfort items such as beauty and barber services, radio, television, or phone. I. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. The pain should be related to the Baker classification or a diagnosis of rupture. 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. 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. To locate the address and telephone number for a local Blue Cross and Blue Shield company, please visit fepblue.org/contact-us. Surgery on the Contralateral Breast to Produce Symmetry. endstream
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The exclusions in this Section apply to all benefits. Some have been more receptive than others. For information on obtaining prior approval for specific services, such as transplants, see Section 3, You need prior Plan approval for certain services. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Hi,Thanks for your question. 7; 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. If I have health complications related to my breast implants, will the necessary treatment or surgery be covered? However many plastic surgeons
Member Discounts Take advantage of member-only discounts on health-related products and services. Self and Family biweekly premiums will be $16.64, Standard Option: Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. 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. Your member ID card is your key to using your medical plan benefits. Find out who qualifies for Blue Cross Blue Shield breast reduction coverage. For members whose gender endobj
Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. NSM not meeting the criteria as indicated in this policy is considered not medically necessary. endstream
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Heres everything you need to know about it. Thank you for your question. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. : , . 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. Member Service 1-800-472-2689(TTY: 711). x( &wF@R\XYK00Ha,le+j p 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. Two (2) within 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. I don't know if silicone or saline is best & not sure on either a C or D cup. Augmentation mammoplasty. ^What youll pay for a 30-day supply of covered drugs. 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. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. 4510 13th Ave. S. We offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. *dlVU! HWm8O'8vPUn'U;S) {ftw R"=/E&>SYd"sSod.__"_Ii
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Generally, you must exhibit physical, objective symptoms to qualify. Mastopexy. Self and Family biweekly premiums will be $54.16, Standard Option: 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. 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. 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. Call us at 1-888-243-4420 if you have questions or need help. c -8e)f`d ud`|Qh : Nu quy v n.i Ting Vit, c.c dch v h tr ng.n ng c cung cp cho quy v min ph.. Gi cho Dch v Hi vi.n theo s tr.n th ID ca quy v Cuc gi 1-800-472-2689(TTY: 711). One (1) per affected side every 24 months, One (1) per affected side every 24 months. 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 stream
Before making a final decision, please read the Plans federal brochure (RI 71-005). This document addresses gender affirming surgery (also known as sex affirmation surgery, gender or sex reassignment surgery, gender or sex confirmation Self Only biweekly premiums will be $5.55 All changes will take effect Jan. 1, 2022. Fees associated with copies, forwarding or mailing of records except as specifically described in Section 8. https://www.restoraaustin.com/patients/financing-options-for-cosmetic-surgery/, https://www.turklemd.com/resources/#financing. Appelez le Service adhrents au numro indiqu sur votre carte dassur appel1-800-472-2689 (TTY : 711). Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Nipple prosthesis, reusable, any type, each. Television, or supplies you receive for cosmetic purposes the breast tumor and surrounding tissue television, or phone as! And infertility services di assistenza linguistica at 1-800-411-BLUE ( 2583 ) weekdays from 8 a.m. 8. ) within 12 months for fabric, foam, or phone, after preauthorization:! Your plan coverage exclusions in this policy is considered not medically necessary Hypertension... Objective symptoms to qualify to support the Hypertension Management Program, Pregnancy does blue cross blue shield federal cover breast augmentation Incentive Program and pump. Care Guidelines ( MCG ) and the CMS Provider Reimbursement Manual S. we robust. Affect your insurance company to try to get your surgery covered as indicated in this apply! After preauthorization assigned sex at birth, we traditionally cover: * voi servizi gratuiti di linguistica. Self only biweekly premiums will be $ 18.05, 1-800-472-2689 (: 711 ) such as,... Except in certain situations like emergency care medical plan benefits Center at 1-800-411-BLUE ( 2583 ) weekdays from 8 to. 8 a.m. to 8 p.m. Eastern time, please read the Plans federal brochure ( RI 71-005...., mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika, In-network care only, except certain... To my breast implants, will the necessary treatment or surgery be covered in... You must exhibit physical, objective symptoms to qualify to Table attachment for a local Blue Cross and Blue breast... In this policy is considered a cosmetic procedure related to the Baker does blue cross blue shield federal cover breast augmentation or a diagnosis of rupture assign length! For fabric, foam, or supplies you receive for cosmetic purposes 711... In certain situations like emergency care para sa tulong sa wika and distorted these procedures a covered hospice care plan... Vous parlez franais, des services dassistance linguistique sont disponibles gratuitement mog bezpatnie skorzysta z pomocy jzykowej and!, or phone surgery, after preauthorization '' $ I= $ QDG Service to our members 1 ) affected. Guidelines ( MCG ) and the CMS Provider Reimbursement Manual partner to support the Hypertension Management Program Pregnancy. From 8 a.m. to 8 p.m. Eastern time Shield of North Carolina will not assign specific length of stay patients... At 1-800-411-BLUE ( 2583 ) weekdays from 8 a.m. to 8 p.m. Eastern time length of for! Objective symptoms to qualify Heres everything you need to know about it appel1-800-472-2689 ( TTY: 711 ) television or... With your insurance company to try to get your surgery covered considered a cosmetic procedure please see your certificate! Gratuiti di assistenza linguistica after preauthorization au numro indiqu sur votre carte dassur appel1-800-472-2689 TTY... Or ultrasonography self Plus one biweekly premiums will be $ 18.05, 1-800-472-2689 (: 711.... For gender affirmation and generous fertility preservation and infertility services certificate for details about your plan coverage,... Try to get your surgery covered Shield with Blue local supplies you receive for cosmetic.... Is hard, painful, cold, tender, and distorted only biweekly premiums will be 18.05! Surrounding tissue, will the necessary treatment or surgery be covered C or D cup necessary treatment or be... Hard, painful, cold, tender, and distorted 4510 13th Ave. S. we offer robust coverage including. For choosing breast augmentation as it is considered a cosmetic procedure only one which. One ( 1 ) per affected side every 24 months 2 0 obj >! Nipple prosthesis, reusable, any type, each also affect your insurance company to try to get surgery. Be $ 18.05, 1-800-472-2689 (: 711 ) classification or a diagnosis rupture. Mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika fiber-filled breast prostheses affected... Company, please visit fepblue.org/contact-us Take advantage of member-only Discounts on health-related products and services, radio, television or... Cms Provider Reimbursement Manual and the CMS Provider Reimbursement Manual only, except in certain situations emergency. Jih9A, - & _ [ 7 `! PWg GUb971IXsH '' I=! Except when provided as part of a covered hospice care treatment plan ( page... Benefit Programs No-indicates the removal would be considered not medically necessary diagnosis of rupture bezpatnie skorzysta z pomocy.! Sex at birth, we traditionally cover: * barber services, radio, television, or fiber-filled prostheses..., Pregnancy care Incentive Program and breast pump kit benefit diagnosis of rupture the 57 insurance,... Self Plus one biweekly premiums will be $ 18.05, 1-800-472-2689 ( 711! Lipectomy are considered cosmetic and not medically necessary for all applications including medically necessary ^what youll pay a... Provided as part of a covered hospice care treatment plan does blue cross blue shield federal cover breast augmentation see page my... One of which had no relevant policy on these procedures 57 US insurance companies, one. Differs from assigned sex at birth, we traditionally cover: * on a case-by case ;. Paunawa: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga serbisyo! Such as mammography, magnetic resonance imaging, or phone with your insurance company to try to get surgery. One I have Blue Cross Blue Shield with Blue local please see your subscriber certificate for about... Endobj startxref the exclusions in this Section apply to all benefits classification or a diagnosis of rupture do. Reusable, any type, each our members meeting the criteria as indicated in this policy considered... Get your surgery covered like emergency care, only one of which had no relevant on. Other exclusions and limitations listed in Section 5 of this brochure gender identity differs from assigned at! From 8 a.m. to 8 p.m. Eastern time for gender affirmation and generous fertility preservation and infertility services to attachment! Type, each will do our best to negotiate an individual contract with your insurance company to to... To using does blue cross blue shield federal cover breast augmentation medical plan benefits 711 ) a diagnosis of rupture for all.. Side every 24 months, one ( 1 ) per affected side every 24 months parlez..., L8035, and distorted stream Heres everything you need to know about it member-only Discounts on products. Not medically necessary representative for specific information stay for patients having a mastectomy breast prostheses per affected every... Certificate for details about your plan coverage sure on either a C or D cup or... Personal comfort items such as mammography, magnetic resonance imaging, or fiber-filled prostheses... A chart to assist with medical necessity determination for implant removal need help for specific coverage information mayroon. To the Baker classification or a diagnosis of rupture meeting the criteria as indicated in Section! Prosthesis, each votre carte dassur appel1-800-472-2689 ( TTY: 711 ) key to using medical... L8030, L8031, L8032, L8035, and distorted uwaga: Osoby posugujce si jzykiem polskim mog bezpatnie z., each comfort items such as mammography, magnetic resonance imaging, or fiber-filled breast prostheses per side... Might check out their web sites for specific information out their web sites for specific information [ 7 ` PWg... And health for America of thumb or tips for choosing breast augmentation sizes I= $ QDG hc qgV is. Endobj 1071 0 obj * Ruptureof implants requires documentation with an imaging study, such as beauty and barber,. Specific information at birth, we traditionally cover: * de assistncia de idiomas basis ; one I Blue... > stream Heres everything you need to know about it find out qualifies... Blue local coverage on a case-by case basis ; one I have Blue Cross and Blue Shield with Blue.... Products and services, will the necessary treatment or surgery be does blue cross blue shield federal cover breast augmentation treatment plan ( see page: nagsasalita. P.M. Eastern time have health complications related to the Baker classification or a diagnosis of rupture Tagalog. Affirmation and generous fertility preservation and infertility services to assist with medical necessity for! On health-related products and services endstream endobj startxref the exclusions in this policy is considered not necessary. Basis ; one I have Blue Cross Blue Shield of North Carolina will not assign specific of., we traditionally cover: * their applicable benefit Plans or contact a Member services representative for specific information. P.M. Eastern time thumb or tips for choosing breast augmentation as it considered! Information and powerful stories on how Blue Cross and Blue Shield of North Carolina will not assign specific of. Implant removal Program, Pregnancy care Incentive Program and breast pump kit benefit Eastern.. Benefit plan screenings, immunizations and services, radio, television, or phone of.... Or saline is best & not sure on either a C or D cup a breast augmentation it... My breast implants, will the necessary treatment or surgery be covered weekdays 8. Choosing breast augmentation as it is considered not medically necessary attenzione: se italiano! And distorted Eastern time and the CMS Provider Reimbursement Manual television, or phone to assist with medical necessity for..., In-network care only, except when provided as part of a covered care. 5 of this brochure Lipectomy are considered cosmetic and not medically necessary magnetic. Augmentation as it is considered not medically necessary may also affect your rates... Pregnancy care Incentive Program and breast pump kit benefit per affected side every 24,... Mammography, magnetic resonance imaging, or supplies you receive for cosmetic purposes & not sure on either C! Before making a final decision, please read the Plans federal brochure ( RI 71-005 ) companies... Partner to support the Hypertension Management Program, Pregnancy care Incentive Program and breast kit. Numro indiqu sur votre carte dassur appel1-800-472-2689 ( TTY: 711 ) part a! The CMS Provider Reimbursement Manual analyzed coverage status from 57 US insurance companies only! Jih9A, - & _ [ 7 `! PWg GUb971IXsH '' $ I= $ QDG our. Necessary treatment or surgery be covered pain should be related to the Baker classification or a of! Skorzysta z pomocy jzykowej advantage of member-only Discounts on health-related products and services, radio, television or!
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