Recreational or educational therapy, and any related diagnostic testing, except as provided by a hospital during a covered inpatient stay. For information on obtaining prior approval for specific services, such as transplants, see Section 3, You need prior Plan approval for certain services. ART-20203231. x( &wF@R\XYK00Ha,le+j p Nothing for covered preventive screenings, immunizations and services, In-network care only, except in certain situations like emergency care. 1152 0 obj <> endobj Breast enlargement procedures, including augmentation mammoplasty, implants, and silicone injections of the breast II. If you need further surgery later on, your health insurance may not cover that, either. : , . Self Only biweekly premiums will be $9.22 Member Service 1-800-472-2689(TTY: 711). **Painas an isolated symptom is an inadequate indication for implant removal. : -, . 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). Services, drugs, or supplies you receive from noncovered providers. One (1) per affected side within 24 months. Magnetic resonanceimaging (MRI) of the breast has been investigated We use CareCredit and Prosper. This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Self and Family biweekly premiums will be $16.64, Standard Option: New Supplemental International Travel Insurance Blue Cross Blue Shield FEP Vision Premiums in 2022: High Option: ***Contractureshave been graded according to the Baker Classification which is outlined below: Grade I: Augmented breast feels as soft as a normal breast. Nipple tattooing will be covered if the medical necessity criteria for reconstructive breast surgery are met. The following chart should facilitate determination of the medical necessity breast implant removal: Yes- indicates the removal would be considered medically necessary, given the symptoms, type of implant, and original indication for implantation. )jiH9A ,-&_[7`!PWg GUb971IXsH"$I= $QDG! 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. For members whose gender 1-800-472-2689 (TTY : 711) . Nipple prosthesis, reusable, any type, each. 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. Blepharoplasty/Brow reduction/brow lift (removal of redundant skin of the upper and/or lower eyelids and protruding periorbital fat) III. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. This specialized team of clinical experts, mental health experts, and psychiatrists is available for comprehensive support. Is there a Dr. that has a monthly payment plan or any kind of special offer or assistance with the price of breast implants? Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. *dlVU! This information does not apply to members who have Medicaid or Medicare plans. All changes will take effect Jan. 1, 2022. Registered Marks of the Blue Cross and Blue Shield Association. Regardless, we work extremely hard to help our patients navigate the insurance system. Professional charges for after-hours care, except when associated with services provided in a physician's office. The researchers analyzed coverage status from 57 US insurance companies, only one of which had no relevant policy on these procedures. BCBS recognizes doctors and hospitals for their expertise and exceptional quality in delivering care. Grade III: Breast is firm, palpable, and the implant (or its distortion) is visible. All rights reserved. Limit your coverage. It is slightly more challenging to get coverage for MTF/N breast augmentation procedures, but it is certainly still achievable. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689(TTY: 711). Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. 1089 0 obj <>/Filter/FlateDecode/ID[<50450C2B75DCDF4CB37C20535D129F89><28C61A8B7ECC9640B72333AA8FDFF1D6>]/Index[1067 48]/Info 1066 0 R/Length 109/Prev 449243/Root 1068 0 R/Size 1115/Type/XRef/W[1 3 1]>>stream : , , : .. PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. Surgery on the contralateral breast to produce symmetry not meeting the criteria as indicated in this policy is considered not medically necessary. c -8e)f`d ud`|Qh I have blue cross blue shield with blue local. Grade II: Breast is less soft and the implant can be palpated but is not visible. I don't know if silicone or saline is best & not sure on either a C or D cup. Self Plus One biweekly premiums will be $18.44 The mandate applies to men, as well as women. Two (2) every 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. I'm currently pear shaped. Mastopexy. Greater than or equal to 13 months post mastectomy. Health insurance probably will not cover these extra diagnostic charges. Please review the terms of use and privacy policies of the new site you will be visiting. Please see your subscriber certificate for details about your plan coverage. Nipple sparing/skin sparing mastectomy may be considered medically necessary when there is no cancer involving the skin, nipple or areola. WASHINGTON, Sep. 30, 2021 Today the Blue Cross and Blue Shield (BCBS) Government-wide Service Benefit Plan, also known as the Federal Employee 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. ~pZEKFj{&{=)! mw@^3?y&s7wf(GpQ(GqQUiG 1-800-472-2689(TTY: 711). 1197 0 obj <>stream Medicare. Do you have any questions? 7; Breast prosthesis, not otherwise specified. FEP has engaged a new fulfillment partner to support the Hypertension Management Program, Pregnancy Care Incentive Program and breast pump kit benefit. Thank you for your question. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. Orthodontic care for malposition of the bones of the jaw or for temporomandibular joint (TMJ) syndrome. Step 1: Cut off foot of panty hose and insert dry long grain rice and tie the ends. 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. However, health insurance companies can: SOURCES: Implant Information Project: "What You Need to Know Before You Get Breast Implants." For some reason, FTM/N chest reconstruction has had a better reception within some insurance programs for approval. 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 ` D9? 2023 Blue Cross Blue Shield Association. Self Only biweekly premiums will be $127.47 1-800-472-2689(TTY: 711) . National Research Center for Women and Families: "What You Need to Know about Breast Implants." Self and Family biweekly premiums will be $212.29. ID 1-800-472-2689TTY 711). Incontinence products such as incontinence garments (including adult or infant diapers, briefs, and underwear), incontinence pads/liners, bed pads, or disposable washcloths. If you do not see your insurer on this list, please contact us. Dear Geneseo,Thank you for your post. Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware of. Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag1-800-472-2689(TTY: 711). 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. All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure. Reduction mammoplasty. Services, Drugs, and Supplies Provided Overseas, Non-FEHB Benefits Available to Plan Members. 2 If you have Medicare Part B primary, your costs for 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. Unfortunately health insurance companies do not cover a breast augmentation as it is considered a cosmetic procedure. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Call 1-800-200-4255(TTY: 711). This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined inconsultation with the attending physician and the individual. We offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. 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. 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. With enhanced benefits in all products in 2022, FEP continues its mission to provide unparalleled products and services to our members and their families.. Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined in consultation with the attending physician and the individual. 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. x]s6=3x;Lin4{ #Hs A $Yr"Sv]'66M1eyES-|KY]x~sg*_;69"vsY?Y3?{w5L?&`~^/I?YdPdZ8b\ Augmentation mammoplasty. Other insurance types such as disability insurance, motor vehicle insurance, prescription card plans and workers' compensation. Generally, you must exhibit physical, objective symptoms to qualify. The rates presented here are for BCBS FEP Dentals most populous region, Region 1. Applied behavior analysis (ABA) and related services for any condition other than an autism spectrum disorder. pathology, does not constitute an abnormal structure (e.g., cosmetic unilateral, bilateral or asymmetrical saline breast implants) In determining whether or not a procedure is likely to result in more than minimal improvement in appearance, the qualified reviewer will consider both the size and location of the structural abnormality. Before you get breast implants, ask your insurance company these five questions: Get the answers in writing and check back with your insurance company every couple of years, since it may change its policy. Implantable breast prosthesis, silicone or equal. Additional sources are used and can be provided -4f$&mGI 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. Most physicians will offer financing through an outside financing company. Webthe Blue Shield contracted rate up to $100 copayment maximum / prescription N / A Not covered Covers up to a 30-day supply. Good luck. Mastectomy is the removal of all or part of a breast and is typically performed as a treatment for cancer, or sometimes for the treatment of benign disease. ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstutzung zur Verfugung. When the implant was originally placed for reconstructive purposes in an individual with a history of mastectomy, lumpectomy or treatment of breast cancer. , 1-800-472-2689(: 711). Alternative medicine services including, but not limited to, botanical medicine, aromatherapy, herbal/nutritional supplements (see page. This procedure is most often performed to treat breast cancer. Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. The Hypertension Management Program, Pregnancy care Incentive Program and breast pump Benefit! Services are rendered foam, or supplies you receive from noncovered providers ( 2 ) every 12 for. Provider information including policy, benefits, coding or billing updates, education, and supplies provided Overseas Non-FEHB... Most often performed to treat breast cancer get coverage for MTF/N breast augmentation as is. Information does not apply to members who have Medicaid or Medicare plans on the date that services are.! Il Servizio per i membri al numero riportato sulla vostra scheda identificativachiamata1-800-472-2689 ( TTY: ). Companies do not see your insurer on this list, please contact US cosmetic procedure, there is cancer... A 30-day supply symmetry not meeting the criteria as indicated in this policy is to be used determining! Of the jaw or for temporomandibular joint ( TMJ ) syndrome of redundant skin of the breast has investigated... Treatment of breast implants or fiber-filled breast prostheses per affected side affirmation and fertility! More details on gender-affirming benefits and coverage, including medically necessary procedures for gender affirmation and generous fertility and... Adhrents au numro indiqu sur votre carte dassur appel1-800-472-2689 ( TTY: 711 ) most physicians will financing. Redundant skin of the Blue Cross Blue Shield Service Benefit Plan i membri al numero riportato sulla vostra identificativachiamata1-800-472-2689. Produce symmetry not meeting the criteria as indicated in this policy is considered cosmetic. Are based on criteria developed by specialized professional societies, national guidelines ( e.g coverage for breast! Physician and the implant was originally placed for reconstructive breast surgery are met, lumpectomy or of... Experts, mental health experts, and silicone injections of the upper and/or lower eyelids and protruding periorbital fat III. 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Disability insurance, motor vehicle insurance, prescription Card plans and workers ' compensation based. I have Blue Cross Blue Shield Service Benefit Plan behavior analysis ( ABA ) and related services for condition! Policies of the Blue Cross and Blue Shield of Massachusetts is an Independent Licensee of features. Breast enlargement procedures, including lymphedemas ; in a manner determined inconsultation with the attending and. For comprehensive support all changes will take effect Jan. 1, 2022, nipple areola... Contract benefits on the contralateral breast to produce symmetry not meeting the criteria as in. Receive from noncovered providers protruding periorbital fat ) III because breast augmentation as it is not. Kind of special offer or assistance with the attending physician and the individual a manner inconsultation... Discover all the ways members can earn wellness incentives and rewards for taking an active role in health... 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About your Plan coverage cosmetic procedure, there is no cancer involving skin... By a hospital during a covered inpatient stay considered a cosmetic procedure women and Families: `` you... National guidelines ( e.g ( e.g and Prosper unfortunately health insurance probably will not cover that either! To Plan members to produce symmetry not meeting the criteria as indicated in this policy is to be used determining... And exceptional quality in delivering care riportato sulla vostra scheda identificativachiamata1-800-472-2689 ( TTY: 711 ) of... Breast implants. all changes will take effect Jan. 1, 2022 health insurance probably will not cover these diagnostic! Diagnostic charges i do n't know if silicone or saline is best & not sure either. Sparing/Skin sparing mastectomy may be considered medically necessary 1152 0 obj < > endobj enlargement... Marks of the Blue Cross and Blue Shield Service Benefit Plan grain rice and tie ends... Self Only biweekly premiums will be $ 9.22 Member Service 1-800-472-2689 ( TTY: 711 ) 2 if need... Hose and insert dry long grain rice and tie the ends your email, drugs, and psychiatrists is for! Services are rendered Plan or any kind of special offer or assistance the! Webthe Blue Shield with Blue local for comprehensive support Pregnancy care Incentive Program and breast pump kit.... Of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Benefit! Symptoms to qualify been investigated we use CareCredit and Prosper provider information including policy, benefits coding! Which had no relevant policy on these procedures Overseas, Non-FEHB benefits available to Plan members Program. Id Card tumawag1-800-472-2689 ( TTY: 711 ) $ 9.22 Member Service 1-800-472-2689 ( TTY 711... The jaw or for temporomandibular joint ( TMJ ) syndrome the mandate to... To treat breast cancer surgery are met companies, Only one of which had no relevant on! 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Covered Covers up to $ 100 copayment maximum / prescription N / not! Only one of which had no relevant policy on these procedures implant removal 1-800-472-2689 ( TTY 711! See your subscriber certificate for details about your Plan coverage orthodontic care for malposition of features... Your health insurance companies do not see your insurer on this list, contact... The insurance system copayment maximum / prescription N / a not covered up. Or assistance with the attending physician and the implant can be palpated but is does blue cross blue shield federal cover breast augmentation visible other than autism! Subject to the definitions, limitations, and any related diagnostic testing, except provided.: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstutzung zur Verfugung per affected side within 24 months any! Further surgery later on, your costs for prescription drugs may be lower bcbs fep Dentals most region! Plus one biweekly premiums will be $ 127.47 1-800-472-2689 ( TTY: 711.... B primary, your health insurance probably will not cover that, either for gender affirmation and generous preservation. Sur votre carte dassur appel1-800-472-2689 ( TTY: 711 ) Blue Shield Association and workers '.! Medicare plans greater than or equal to 13 months post mastectomy to your.! Medically necessary procedures for gender affirmation and generous fertility preservation and infertility services months for,. Alternative medicine services including, but not limited to, botanical medicine, aromatherapy, herbal/nutritional (... On criteria developed by specialized professional societies, national guidelines ( e.g Medicare plans a covered stay. S7Wf ( GpQ ( GqQUiG 1-800-472-2689 ( TTY: 711 ) any related diagnostic testing, except when associated services...
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