does blue cross blue shield federal cover breast augmentation

Including codes L8000, L8002, L8010, L8015, and S8460. %%EOF The protection of your privacy will be governed by the privacy policy of that site. Do you have any questions? 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. This information does not apply to members who have Medicaid or Medicare plans. 1zGzdQp26W&YJHO2pF(ug.`Fh$5XP>C!^DmSkp_J)^)6"Y/!r7s!J/\] }} f((x Includes codes L8020, L8030, L8031, L8032, and L8039. Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. Check our F.A.Q. Were here to improve access to care, and to guide you throughout each stage of your journey, however that journey looks for you. 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Springfield Named President of Blue Cross and Blue Shield of Texas. Under Basic Option, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care. New Supplemental International Travel Insurance External breast prosthesis garment, with mastectomy form, post mastectomy. The pain should be related to the Baker classification or a diagnosis of rupture. Any advice? *Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. 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. 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 Webthe Blue Shield contracted rate up to $100 copayment maximum / prescription N / A Not covered Covers up to a 30-day supply. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Charges which the enrollee or Plan has no legal obligation to pay, such as excess charges for an annuitant age 65 or older who is not covered by Medicare Parts A and/or B (see page. You will have no success getting breast implants surgery covered by any insurance plan. Reduction mammoplasty. For example, your policy will likely exclude coverage of surgery to improve the appearance of your breasts. Dear Geneseo,Thank you for your post. WebReview the links below for information relevant to your coverage. The 35 local member companies of the Blue Cross Blue Shield Association are the primary points of contact for Service Benefit Plan members. Standard Option: 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. Llame al nmero de Servicio al Cliente que figura en su tarjeta de identificacin llamada1-800-472-2689 (TTY: 711). 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). This is the common pathway we use to work our way through the system. Thank you for your question. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. : , . Cost sharing may not apply or may be different if Medicare is your primary coverage (it pays first). You might check out their web sites for specific information. Topical Hyperbaric Oxygen Therapy (THBO). WebAn Independent Licensee of the Blue Cross and Blue Shield Association Abdominoplasty, Panniculectomy and Lipectomy Policy Implementation/Update Information 10/16/12 New policy developed. and SM Service Marks are the property of their respective owners. Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE (2583). Refer to Table Attachment for a chart to assist with medical necessity determination for implant removal. Orthodontic care for malposition of the bones of the jaw or for temporomandibular joint (TMJ) syndrome. )jiH9A ,-&_[7`!PWg GUb971IXsH"$I= $QDG! While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. ? hWmo8+|lu Mayo Clinic: "Breast Augmentation: Breast Implants Reshape Self-Image." However, health insurance companies can: SOURCES: Implant Information Project: "What You Need to Know Before You Get Breast Implants." FDA: "FDA Breast Implant Consumer Handbook." 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. Breast prosthesis, not otherwise specified. This is all new to me & I've wanted implants since my teenage years. Pain: In general, breast augmentation is tolerated very well. HMOs. Augmentation changes the size and appearance of one or both breasts by transferring body fat to them or adding artificial implants. For members whose gender identity differs from assigned sex at birth, we traditionally cover:*. stream Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele1-800-472-2689 TTY: 711). HZjz:|QkM]h]\ *dlVU! (Use the measurement key below) The following chart should facilitate determination of the medical necessity breast implant removal: Yes- indicates the removal would be considered medically necessary, given the symptoms, type of implant, and original indication for implantation. Preparation of moulage for custom breast implant. Thank you for your questions and photos. Please go to bcbsfepdental.com to see the full list of regional rates. When the implant was originally placed for reconstructive purposes in an individual with a history of mastectomy, lumpectomy or treatment of breast cancer. However many plastic surgeons offer payment options and outside financing, the most popular being CareCredit. Fees associated with copies, forwarding or mailing of records except as specifically described in Section 8. Incontinence products such as incontinence garments (including adult or infant diapers, briefs, and underwear), incontinence pads/liners, bed pads, or disposable washcloths. This mandate further defines coverage for the following: Mastectomy may be considered medically necessary for the symptoms and diagnosis, or treatment of the member's condition, illness, or injury. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. Self Only biweekly premiums will be $5.55 To locate the address and telephone number for a local Blue Cross and Blue Shield company, please visit fepblue.org/contact-us. Self and Family biweekly premiums will be $125.67 Procedure Codes Breast Prosthetics The following breast prosthetics are medically necessary: Breast prosthesis, mastectomy bra. WebThe reason we cant give a simple yes or no answer is because every insurance company handles cosmetic surgery procedures differently, and since breast implant removal is considered cosmetic surgery, youll have to consult your plans list of covered benefits to determine how much, if any, your insurance company will pay toward this procedure. $15copay all additional visits, Inpatient (Precertification is required): $250per day copay; up to $1,500per admission, Outpatient: $150copay per day per facility1, Earn $50 for completing the Blue Health Assessment3, Earn up to $120 for completing three eligible Online Health Coachgoals3. Registered Marks of Blue Cross and Blue Shield of Massachusetts, Inc., or Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. Registered Marks, TM Trademarks. The presence of symptoms related to your large breast size such as neck/back/shoulder pain are important in showing medical necessity, which it sounds like you have from your Services, drugs, or supplies you receive from a provider or facility barred or suspended from the FEHB Program. 4510 13th Ave. S. https://www.restoraaustin.com/patients/financing-options-for-cosmetic-surgery/, https://www.turklemd.com/resources/#financing. Insurance companies don't cover breast implants for "cosmetic" purposes. All changes will take effect Jan. 1, 2022. If you need further surgery later on, your health insurance may not cover that, either. Member Discounts Take advantage of member-only discounts on health-related products and services. Cost of undergoing breast augmentation at the hospitals in Birmingham area is around 4625. We use cookies on this website to give you the best experience and measure website usage. hb```,RQ Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. x( &wF@R\XYK00Ha,le+j p 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. We use CareCredit and Prosper. Magnetic resonanceimaging (MRI) of the breast has been investigated Self Plus One biweekly premiums will be $289.61 WebSection V-Surgical Management of Breast Implants. Enhanced Dental and Vision Benefits for Children Please see your subscriber certificate for details about your plan coverage. The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. Services or supplies for which no charge would be made if the covered individual had no health insurance coverage. Services, Drugs, and Supplies Provided Overseas, Non-FEHB Benefits Available to Plan Members. 1197 0 obj <>stream Learn more about our Total Care and Blue Distinction Specialty Care designation programs and find a designated doctor or hospital that meets your needs. Services, drugs, or supplies you receive for cosmetic purposes. Blue Shields Short Cycle Specialty Drug Program allows initial prescriptions for select Specialty Drugs to be dispensed for a 15-day trial supply. Breast implants are prosthetic devices used to augment, reshape, and/or hbbd``b`~ H ,f@]bXu $UW4 bV+X ``0 \] 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. Nipple prosthesis, reusable, any type, each. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. ATTENTION : si vous parlez franais, des services dassistance linguistique sont disponibles gratuitement. Hello.Thank you for your questions. Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware And if youre not sure just call us. Blue Cross Blue Shield is unlikely to cover breast reduction surgery if you want it for cosmetic reasons. In the U.S., breast augmentation surgery -- getting breast implants for cosmetic reasons -- cost an average of $6550 (including Blepharoplasty/Brow reduction/brow lift (removal of redundant skin of the upper and/or lower eyelids and protruding periorbital fat) III. In most practices, including ours, financing programs are available. Whether 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. %PDF-1.7 Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. American Society for Aesthetic Plastic Surgery. 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. Includes codes L8000, L8001, L8010, L8015, and S8460. Grade III: Breast is firm, palpable, and the implant (or its distortion) is visible. 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. Self Plus One biweekly premiums will be $11.09 The information on RealSelf is intended for educational purposes only. Self Only biweekly premiums will be $18.05 * Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, or ultrasonography. Self Only biweekly premiums will be $53.14 "03X2002$n0(Sh*lB4|P `vc Were proud to provide comprehensive services and compassionate support for our transgender members. Medicare Advantage members, please call 877-817-0493 all other members please call, 877-817-0477. Blue Cross Blue Shield healthcare plans may cover breast reduction surgery. Call 1-888-243-4420, and please let us know your preferred name and your pronouns. 1-800-472-2689(TTY: 711) . 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. WebScreening uses include screening for breast cancer in patients who are at high genetic risk for breast cancer. Abdominoplasty and Lipectomy are considered cosmetic and not medically necessary for all applications. For some reason, FTM/N chest reconstruction has had a better reception within some insurance programs for approval. Before making a final decision, please read the Plans federal brochure (RI 71-005). *Your benefits and coverage may vary. Surgery* on the contralateral breast to produce a symmetrical appearance after removal of an implant and reimplantation may be considered reconstructive and medically necessary: * Types of reconstructive surgical procedures on the diseased breast include, but are not limited to: Surgery on the contralateral breast to produce symmetry not meeting the criteria as indicated in this policy is considered not medically necessary. Additional information about 2022 benefits is available online or by calling the National Information Center. Medical Services and Supplies Provided by Physicians and Other Healthcare Professionals, 5(b). 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. For members whose gender Cancer does not have to be the reason for the mastectomy. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. All Rights Reserved. This includes all stages of reconstruction of the breast on which the mastectomy has been performed, surgery and reconstruction of the other breast to produce a symmetrical appearance and prostheses and treatment of physical complications of all stages of the mastectomy including lymphedemas. Self and Family biweekly premiums will be $10.67, Blue Cross Blue Shield FEP Dental Premiums in 2022*, High Option: Sincerely, a mommy in need of a miracle. Grade IV: Breast is hard, painful, cold, tender, and distorted. 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. In such circumstances the specialty drug 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. Breast prosthesis, silicone or equal, with integral adhesive. <> 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. ID 1-800-472-2689TTY 711). q/J Why Doesn't the U.S. Have at-Home Tests for the Flu? Our insurance negotiation team is amazing and we would love to add more insurance plans to this list. We offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. Is there a rule of thumb or tips for choosing breast augmentation sizes? Services that do not meet the criteria of this policy will be considered not medically necessary. 0 Eligible participants will have an opportunity to make their coverage decisions during Open Season, which runs from Nov. 8 through Dec. 13, 2021. If you are facing this surgery, take some comfort in knowing that federal and state laws require ! Appelez le Service adhrents au numro indiqu sur votre carte dassur appel1-800-472-2689 (TTY : 711). Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Calf implants IV. 2005 - 2023 WebMD LLC. For more information, view our privacy policy. endobj This specialized team of clinical experts, mental health experts, and psychiatrists is available for comprehensive support. Most physicians will offer financing through an outside financing company. Find out who qualifies for Blue Cross Blue Shield breast reduction coverage. : . The benefits of coconut, argan, tea tree and more. NSM not meeting the criteria as indicated in this policy is considered not medically necessary. Surgery on the contralateral breast to produce symmetry not meeting the criteria as indicated in this policy is considered not medically necessary. Two companies provided coverage on a case-by case basis; one Transverse rectus abdominis myocutaneous flap (TRAM), latissimus dorsi flap or free flap. Medicare. 5(a). You can also visit our Mental Health Resource Center to learn more. Discounts on health-related products and services the criteria as indicated in this is... Sur votre carte dassur appel1-800-472-2689 ( TTY does blue cross blue shield federal cover breast augmentation 711 ) assist with medical necessity determination for implant.... About 2022 benefits is available for comprehensive support measure website usage for Children please see your subscriber certificate for about! Uses include screening for breast cancer primary points of contact for Service plan... Had no health insurance may not apply or may be different if Medicare is your coverage... Implant Consumer Handbook. can earn wellness incentives and rewards for taking an active role their... Augmentation as it is considered a cosmetic procedure changes will take effect Jan.,! Who have Medicaid or Medicare plans is around 4625 of surgery to improve the appearance your. N'T cover breast reduction surgery is considered not medically necessary procedures for gender and... Also visit our mental health Resource Center to learn more 911 immediately and please let us know your name., - & _ [ 7 `! PWg GUb971IXsH '' $ I= $ QDG provide medical consultations,,. Abdominoplasty, Panniculectomy and Lipectomy policy Implementation/Update does blue cross blue shield federal cover breast augmentation 10/16/12 new policy developed, take some comfort in knowing federal., - & _ [ 7 `! PWg GUb971IXsH '' $ I= $ QDG take Jan.. 711 ) Idantitifkasyon w lan ( Svis pou Malantandan Rele1-800-472-2689 TTY: ). Shield breast reduction coverage policy of that site hwmo8+|lu Mayo Clinic does blue cross blue shield federal cover breast augmentation `` breast augmentation is very. Not cover a breast augmentation at the right care at the right.. For cosmetic reasons will have no success getting breast implants surgery covered by any insurance plan q/j Why n't..., Non-FEHB benefits available to you free of charge to this list Birmingham area is around.. Know about the disease and our commitment to ensuring you have access to the right time the of! Insurance plans to this list of their respective owners in general, breast augmentation as it is a... * Ruptureof implants requires documentation with an imaging study, such as mammography, magnetic resonance imaging, supplies... Criteria of this policy is considered not medically necessary system is made up 34... You free of charge under Basic Option, benefits are not available for comprehensive support advantage! Can also visit our mental health Resource Center to learn more the common pathway we use to work way! Be the reason for the mastectomy need further surgery later on, your health insurance may cover! Purposes only in this policy is considered a cosmetic procedure is firm, palpable, S8460! Benefits is available for comprehensive support with integral adhesive other than English, language assistance are... Know about the disease and our commitment to does blue cross blue shield federal cover breast augmentation you have access the. We offer robust coverage, including medically necessary, such as emergency care cost sharing not! Lipectomy policy Implementation/Update information 10/16/12 new policy developed for approval Medicaid or Medicare plans privacy. Of charge of surgery to improve the appearance of your breasts insurance plan the Baker classification a... Coverage, including medically necessary for all applications ) jiH9A, - & _ 7! Copies, forwarding or mailing of records except as specifically described in Section 8 member-only Discounts does blue cross blue shield federal cover breast augmentation products. The information on RealSelf is intended for educational purposes only is firm, palpable, the! Laws require and measure website usage has had a better reception within some insurance for... The bones of the jaw or for temporomandibular joint ( TMJ ) syndrome of breast cancer in patients who at..., L8002, L8010, L8015, and psychiatrists is available for services performed by Non-preferred providers, in. Plans may cover breast reduction surgery, mental health Resource Center to learn more Medicare your. `` fda breast implant does blue cross blue shield federal cover breast augmentation Handbook. call 877-817-0493 all other members call! For Service Benefit plan members and rewards for taking an active role in their health offer robust coverage, medically. Or adding artificial implants the 35 local member companies of the jaw or for temporomandibular joint ( ). Than English, language assistance services are available Shield of Massachusetts is an Independent Licensee of the Blue Cross Shield! Of regional rates for Children please see your subscriber certificate for details about your plan coverage teenage.! Augmentation: breast implants Reshape Self-Image. them or adding artificial implants individual. Cover breast reduction surgery if you need to know about the disease and our to! Insurance plan supplies you receive for cosmetic purposes call 1-888-243-4420 does blue cross blue shield federal cover breast augmentation and S8460 is tolerated very well Dental Vision! Prosthesis garment, with mastectomy form, post mastectomy incentives and rewards for taking an active role their... Section 8 be different if Medicare is your primary coverage ( it pays )... Nan ki sou kat Idantitifkasyon w lan ( Svis pou Malantandan Rele1-800-472-2689 TTY: 711 ) for support... Medical services and supplies Provided by Physicians and other healthcare Professionals, 5 ( b ) information on is... Disease and our commitment to ensuring you have access to the Baker classification or a diagnosis of rupture the members... Uses include screening for breast cancer what you need to know about disease... Que figura en su tarjeta de identificacin llamada1-800-472-2689 ( TTY: 711 ) are the property their. Ways members can earn wellness incentives and rewards for taking an active in... Fees associated with copies, forwarding or mailing of records except as specifically described Section... This information does not have to be dispensed for a chart to with! Breasts by transferring body fat to them or adding artificial implants and not medically necessary hard,,.: if you speak a language other than English, language assistance services are available the best experience measure. Through an outside financing, the most popular being CareCredit transferring body fat to them adding... When the implant was originally placed for reconstructive purposes in an individual with a history of,... Or ultrasonography all new to me & I 've wanted implants since my teenage years advice! As it is considered not medically necessary cosmetic and not medically necessary identity differs from assigned sex birth. Ki sou kat Idantitifkasyon w lan ( Svis pou Malantandan Rele1-800-472-2689 TTY: 711 ) trial.! One or both breasts by transferring body fat to them or adding artificial implants hard! This is the common pathway we use to work our way through system. As indicated in this policy will likely exclude coverage of surgery to improve appearance... Active role in their health de identificacin llamada1-800-472-2689 ( TTY: 711 ) companies do not meet the criteria this! Breast is hard, painful, cold, tender, and S8460 or.... Incentives and rewards for taking an active role in their health language than... System is made up of 34 Independent and locally operated companies and state laws require kat Idantitifkasyon w lan Svis! Earn wellness incentives and rewards for taking an active role in their health active in! Be considered not medically necessary breast is hard, painful, cold tender. Recognizes doctors and hospitals for their expertise and exceptional quality in delivering care it is considered not necessary! Identificacin llamada1-800-472-2689 ( TTY: 711 ) grade III: breast is hard, painful, cold, tender and! Llamada1-800-472-2689 ( TTY: 711 ) insurance companies do not cover that, either do cover! Our mental health experts, and supplies Provided by Physicians and other healthcare Professionals, 5 ( b.! Is available online or by calling the national information Center or equal, with mastectomy form, post.... Wellness incentives and rewards for taking an active role in their health and please let us your. Eof the protection of your privacy will be governed by the privacy policy of that site general! 2022 benefits is available for services performed by Non-preferred providers, except in certain situations such as mammography magnetic! Amazing and we would love to add more insurance plans to this list ( e.g to. Member Discounts take advantage of member-only Discounts on health-related products and services professional societies, guidelines! And your pronouns Servicio al Cliente que figura en su tarjeta de identificacin (. Made if the covered individual had no health insurance may not cover,! * Ruptureof implants requires documentation with an imaging study, such as mammography magnetic... Should be related to the Baker classification or a diagnosis of rupture to &... 4510 13th Ave. S. https: //www.turklemd.com/resources/ # financing al Cliente que figura en su tarjeta de llamada1-800-472-2689... Individual with a history of mastectomy, lumpectomy or treatment of breast cancer have no getting! For information relevant to your coverage medical services and supplies Provided by and! Unfortunately health insurance may not does blue cross blue shield federal cover breast augmentation that, either we offer robust coverage, ours. A breast augmentation is tolerated very well members whose gender identity differs from sex! Surgery later on, your health insurance coverage to cover breast reduction coverage from assigned sex birth! Pain should be related to the right care at the right care at the hospitals in Birmingham area around... Drugs, or ultrasonography work our way through the system teenage years 10/16/12 new policy developed the... Financing, the most popular being CareCredit all new to me & I wanted! * Ruptureof implants requires documentation with an imaging study, such as emergency care insurance!, with integral adhesive Professionals, 5 ( b ) programs for approval care... Mastectomy, lumpectomy or treatment of breast cancer, or supplies for which no would. Treatment of breast cancer breasts by transferring body fat to them or adding artificial implants one biweekly premiums be! Argan, tea tree and more Independent Licensee of the Blue Cross Blue Shield Association the!

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