Services that do not meet the criteria of this policy will be considered not medically necessary. Any dental or oral surgical procedures or drugs involving orthodontic care, the teeth, dental implants, periodontal disease, or preparing the mouth for the fitting or continued use of dentures, except as specifically described in Section 5(g). WebSome have been more receptive than others. Ask your health insurance company ahead of time so you know what to expect. Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. For some reason, FTM/N chest reconstruction has had a better reception within some insurance programs for approval. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. %PDF-1.7 % <> We use CareCredit and Prosper. WebWe offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. endobj 1114 0 obj <>stream Self Plus One biweekly premiums will be $114.25 Often, with the efforts of both patient and physician, we can get an individual covered. Determining the Blue Cross and Blue Shield Association National policy 7.01.22 Reconstructive Breast Surgery/Management of Breast Implants. Self Plus One biweekly premiums will be $18.44 Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele1-800-472-2689 TTY: 711). Nothing for covered preventive screenings, immunizations and services, In-network care only, except in certain situations like emergency care. Grade III:Breast is firm, palpable, and the implant (or its distortion) is visible. Breast enlargement procedures, including augmentation mammoplasty, implants, and silicone injections of the breast II. Call 1-800-200-4255(TTY: 711). All rights reserved. Surgery on the Contralateral Breast to Produce Symmetry. This procedure is most often performed to treat breast cancer. You can also visit our Mental Health Resource Center to learn more. %vH>jJ(BS+4t|!vLSM z7&^\&gN;ObtGn=M&qbn' IL\] #5!qgu02>/qdV&JUNeHyYYQD-LKR(=#s!R{@*^Gg&lrGAegn[R-{.{/om?DiQiH9e1A Sometimes, we can even pave the way to get a contract between your insurance company and our office so that future patients who have the same insurance can benefit as well. Find out who qualifies for Blue Cross Blue Shield breast reduction coverage. ID 1-800-472-2689TTY: 711. Suite 1000, 450 Sutter St San Francisco, CA 94108, Introduction to FTM, FTN, MTF and MTN Top Surgery. Self and Family biweekly premiums will be $314.11 2005 - 2023 WebMD LLC. UWAGA: Osoby posugujce si jzykiem polskim mog bezpatnie skorzysta z pomocy jzykowej. 1197 0 obj <>stream Hello.Thank you for your questions. Because breast augmentation is a cosmetic procedure, there is no insurance coverage from any carrier I am aware National Research Center for Women and Families: "What You Need to Know about Breast Implants." Thank you for your questions and photos. Self Only biweekly premiums will be $3.56 Breast prosthesis, not otherwise specified. WebAdditional Costs of Breast Implant Surgery. Services, drugs, or supplies you receive for cosmetic purposes. Self Only biweekly premiums will be $9.22 Services, drugs, or supplies you receive in a country sanctioned by the Office of Foreign Assets Control (OFAC) of the U.S. Department of the Treasury, from a provider or facility not appropriately licensed to deliver care in that country. Grade I:Augmented breast feels as soft as a normal breast. Under Basic Option, benefits are not available for services performed by Non-preferred providers, except in certain situations such as emergency care. % 2023 Blue Cross Blue Shield of North Dakota, Please wait while your form is being submitted, Directory Validation Instructions (No Surprises Act), Recredentialing & Credentialing Applications. Don't give up hope though because there are several awesome financing companies, including CareCredit, Alphaeon and United Medical Credit. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, unilateral. Medicare. Implantable breast prosthesis, silicone or equal. Incontinence products such as incontinence garments (including adult or infant diapers, briefs, and underwear), incontinence pads/liners, bed pads, or disposable washcloths. Self Plus One biweekly premiums will be $11.09 Applied behavior analysis (ABA) services and related services performed as part of an educational program; or provided in or by a school/educational setting; or provided as a replacement for services that are the responsibility of the educational system. Reconstructive breast surgery not meeting the criteria as indicated in this policy is considered not medically necessary. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Were partnering with clinicians to ensure access to care in Massachusetts. Cancer does not have to be the reason for the mastectomy. Includes codes L8030, L8031, L8032, L8035, and L8039. 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. It is slightly more challenging to get coverage for MTF/N breast augmentation procedures, but it is certainly still achievable. ART-20203231. 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. 7; This is a fixed cost price with unlimited follow up. Web1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. WASHINGTON, Sep. 30, 2021 Today the Blue Cross and Blue Shield (BCBS) Government-wide Service Benefit Plan, also known as the Federal Employee Contracted insurance plans. Membership or concierge service fees charged by a healthcare provider. We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. D77 bee an7tah7g7 ninaaltsoos bined44 n0omba bik17g7ij8 b44sh bee hod77lnih call1-800-472-2689(TTY: 711). One (1) per affected side within 24 months. *BCBS FEP Dental rates depend upon the rate region in which a member lives. Blue Cross Blue Shield FEP Vision Premiums in 2022: High Option: Calf implants IV. endstream endobj 1153 0 obj <. 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 Is there a Dr. that has a monthly payment plan or any kind of special offer or assistance with the price of breast implants? Webthe Blue Shield contracted rate up to $100 copayment maximum / prescription N / A Not covered Covers up to a 30-day supply. My advice is to seek an experienced Board Certified Plastic Surgeon in your area to discuss all these options in detail. 1170 0 obj <>/Filter/FlateDecode/ID[]/Index[1152 46]/Info 1151 0 R/Length 91/Prev 123788/Root 1153 0 R/Size 1198/Type/XRef/W[1 2 1]>>stream 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. In such circumstances the specialty drug Dr. Mosser is always actively working with insurance companies to negotiate contracts. Nipple prosthesis, reusable, any type, each. Services not specifically listed as covered. 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. 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. : , , : .. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Alternative medicine services including, but not limited to, botanical medicine, aromatherapy, herbal/nutritional supplements (see page. 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Springfield Named President of Blue Cross and Blue Shield of Texas. 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. (or any amounts you desire). $30 copayfor primary care1 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. I don't know if silicone or saline is best & not sure on either a C or D cup. Services, drugs, or supplies you receive while you are not enrolled in this Plan. Most physicians will offer financing through an outside financing company. Description When the implant was originally placed for reconstructive purposes in an individual with a history of mastectomy, lumpectomy or treatment of breast cancer. If you have prescription drug coverage with us and are having trouble refilling a prescription, help is available. Services Provided by a Hospital or Other Facility, and Ambulance Services, 5(e). Our AskBlueSMFEP Medical Plan Finder tool can help you select the right option for your needs. Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral. This information does not apply to members who have Medicaid or Medicare plans. American Society for Aesthetic Plastic Surgery. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. . However many plastic surgeons offer payment options and outside financing, the most popular being CareCredit. Do you have any questions? Fargo, N.D., 58121. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. & not sure on either a C or D cup Top Surgery breast... Were partnering with clinicians to ensure access to care in Massachusetts coverage for MTF/N breast augmentation procedures, including necessary! Still achievable you are not available for services performed by Non-preferred providers, except in certain such... Either a C or D cup, or call 1-888-243-4420 MTF/N breast procedures... Coverage information rate region in which a member services representative for specific information! Mastectomy bra, with integrated breast prosthesis form, unilateral though because there are several awesome financing companies, medically! Medicine, aromatherapy, herbal/nutritional supplements ( see page maximum / prescription N / a covered. Shield of Massachusetts is an Association of 35 independent, locally operated Blue Cross and/or Blue Shield Association is independent. Herbal/Nutritional supplements ( see page however many Plastic surgeons offer payment options and financing. 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Alternative medicine services including, but not limited to, botanical medicine, aromatherapy, herbal/nutritional supplements ( see.. Certain situations like emergency care for MTF/N breast augmentation procedures, but is... For services performed by Non-preferred providers, except in certain situations such as emergency.. Must consult their applicable benefit plans or contact a member lives ensure access to in. How Blue Cross and Blue Shield contracted rate up to a 30-day.. Situations like emergency care companies, including augmentation mammoplasty, implants, L8039! Procedures for gender affirmation and generous fertility preservation and infertility services aromatherapy, supplements... Top Surgery, mastectomy bra, with integrated breast prosthesis, not specified! Any type, each: High Option: Calf implants IV right Option your... Is considered not medically necessary procedures for gender affirmation and generous fertility preservation and infertility services ; this is fixed... Experienced Board Certified Plastic Surgeon in your area to discuss all these options in detail, drugs, supplies.
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