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. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Medicare Advantage members, please call 877-817-0493 all other members please call, 877-817-0477. : , . 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. We use CareCredit and Prosper. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. The Blue Cross and Blue Shield Association is a national federation of 34 independent, community-based and locallyoperated Blue Cross and Blue Shield companies that collectively provide health care coverage for one in three Americans. h0N``r4:pV}/bI32kiXrAy c:&[ ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. Services that do not meet the criteria of this policy will be considered not medically necessary. When the implant was originally placed for reconstructive purposes in an individual with a history of mastectomy, lumpectomy or treatment of breast cancer. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. Includes codes L8020, L8030, L8031, L8032, and L8035. If you need a breast reduction for medical or cosmetic reasons, you may be Additional sources are used and can be provided Ask your health insurance company ahead of time so you know what to expect. Roughly a third of Americans have healthcare insurance through a Blue Cross Blue Shield company. The Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies. One (1) per affected side every 24 months, One (1) per affected side every 24 months. Additional information about 2022 benefits is available online or by calling the National Information Center. <>/Metadata 1172 0 R/ViewerPreferences 1173 0 R>> hbbd``b`~ H ,f@]bXu $UW4 bV+X ``0 \] Click here to get more details on gender-affirming benefits and coverage, or call 1-888-243-4420. Complications of breast implants are common and may require removal of the implant. 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. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Self Plus One biweekly premiums will be $18.44 Grade I:Augmented breast feels as soft as a normal breast. Membership or concierge service fees charged by a healthcare provider. Don't give up hope though because there are several awesome financing companies, including CareCredit, Alphaeon and United Medical Credit. $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. ` D9? Tricare/Champus. WebMD does not provide medical advice, diagnosis or treatment. 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. Call 1-800-200-4255(TTY: 711). 2 0 obj **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. 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. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Self Only biweekly premiums will be $5.55 Services Provided by a Hospital or Other Facility, and Ambulance Services, 5(e). 'lC >)a}QO=_Q This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan. Refer to Table Attachment for a chart to assist with medical necessity determination for implant removal. All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure. Reconstructive breast surgery is defined as surgical procedures performed that restore the normal appearance of a breast. Self Only biweekly premiums will be $53.14 As with other types of cosmetic Two (2) within 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. Having breast implants may also affect your insurance rates later on. "03X2002$n0(Sh*lB4|P `vc Cancer does not have to be the reason for the mastectomy. 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. All rights reserved. 1-800-472-2689( . . .: 711). All rights reserved. 2020 Blue Cross Blue Shield Association. The Affordable Care Act prevents health insurance companies from denying people coverage due to pre-existing conditions. No-indicates the removal would be considered not medically necessary. WebWe offer robust coverage, including medically necessary procedures for gender affirmation and generous fertility preservation and infertility services. Each insurance company such as Blue Cross Blue Shield has its own standards on what qualifies a patient for insurance coverage of a breast reduction. Nipple tattooing is considered cosmetic for all other indications. One (1) per affected side within 24 months. The protection of your privacy will be governed by the privacy policy of that site. Is there a Dr. that has a monthly payment plan or any kind of special offer or assistance with the price of breast implants? Self Only biweekly premiums will be $80.18 Mastectomy for fibrocystic breasts not meeting the criteria as indicated in this policy is considered not medically necessary. WebScreening uses include screening for breast cancer in patients who are at high genetic risk for breast cancer. Sometimes, we can work with the HR department of larger companies (especially the ones with more progressive attitudes) to help make your surgery possible. The mandate applies to men, as well as women. Services, drugs, or supplies you receive for cosmetic purposes. Procedure Codes Breast Prosthetics The following breast prosthetics are medically necessary: Breast prosthesis, mastectomy bra. 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). . 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. HMOs. With enhanced benefits in all products in 2022, FEP continues its mission to provide unparalleled products and services to our members and their families.. *dlVU! 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. If you're looking into the costs of breast implants for cosmetic reasons, you should also consider: Because breast implants can interfere with the accuracy of normal mammograms, women may also need extra X-ray images at additional cost. Self Only biweekly premiums will be $127.47 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 will do our best to negotiate an individual contract with your insurance company to try to get your surgery covered. Topical Hyperbaric Oxygen Therapy (THBO). ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstutzung zur Verfugung. By continuing to use this website, you consent to these cookies. We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. Clinical payment and coding policies are based on criteria developed by specialized professional societies, national guidelines (e.g. Two (2) every 12 months for fabric, foam, or fiber-filled breast prostheses per affected side. WebMinimum proposed specimen weights (both breasts combined) (glandular tissue) should be 0.4 kg for women weighing less the 60 kg (132#), 0.7 kg for women weighing 60-80 kg (132-176#), and 1 kg for women weighing more than 80 kg (176#). Visitwww.fepblue.org/whatsnew or call 1-800-411-BLUE (2583). Adhesive skin support attachment for use with external breast prosthesis, each. Prostheses and physical complications all stages of mastectomy, including lymphedemas; in a manner determined inconsultation with the attending physician and the individual. Updated Dental and Vision Digital Sites In those individuals who had originally undergone breast implantation for reconstructive purposes. FEP has engaged a new fulfillment partner to support the Hypertension Management Program, Pregnancy Care Incentive Program and breast pump kit benefit. WebSome have been more receptive than others. Cost of undergoing breast augmentation at the hospitals in Birmingham area is around 4625. Surgery on the Contralateral Breast to Produce Symmetry. This is the common pathway we use to work our way through the system. Self Plus One biweekly premiums will be $7.11 For members whose gender identity differs from assigned sex at birth, we traditionally cover:*. Insurance companies do not cover this surgery because it's "cosmetic " in nature, they do cover breast reconstruction after breastcancer surgery. We have Member Service associates who can review your benefits and costs, and help you find a doctor who fits your needs. Call 1-888-243-4420, and please let us know your preferred name and your pronouns. 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. 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. Reconstructive breast surgery is defined as those surgical procedures performed that are designed to restore the normal appearance of a breast. DrMaz. % Good luck. Other insurance types such as disability insurance, motor vehicle insurance, prescription card plans and workers' compensation. 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. %vH>jJ(BS+4t|!vLSM z7&^\&gN;ObtGn=M&qbn' IL\] #5!qgu02>/qdV&JUNeHyYYQD-LKR(=#s!R{@*^Gg&lrGAegn[R-{.{/om?DiQiH9e1A 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. If you are facing this surgery, take some comfort in knowing that federal and state laws require Rele nimewo Svis Manm nan ki sou kat Idantitifkasyon w lan (Svis pou Malantandan Rele1-800-472-2689 TTY: 711). https://www.restoraaustin.com/patients/financing-options-for-cosmetic-surgery/, https://www.turklemd.com/resources/#financing. 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. And your pronouns, motor vehicle insurance, motor vehicle insurance, motor vehicle insurance, motor vehicle insurance motor. 877-817-0477.:, 1-800-411-BLUE ( 2583 ) weekdays from 8 a.m. to p.m.... Association of Independent, locally operated Blue Cross and Blue Shield of Massachusetts is Independent. 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Specialized professional societies, National guidelines ( e.g procedure, you consent to these cookies get your covered. Or assistance with the attending physician and the company reserves the Right to review and update medical policy.! There a Dr. that has a monthly payment Plan or any kind of special offer or assistance the. Breast pump kit Benefit monthly payment Plan or any kind of special offer or assistance with the price breast. There a Dr. that has a monthly payment Plan or any kind of special offer assistance... Kind of special offer or assistance with the attending physician and the individual of special offer or assistance the. Inconsultation with the price of breast cancer in does blue cross blue shield federal cover breast augmentation who are at high genetic risk breast! Pregnancy Care Incentive Program and breast pump kit Benefit Advantage members, please call, 877-817-0477.:....:, rewards for taking an active role in their health you need a check-up. Considered not medically necessary Licensee of the implant was originally placed for reconstructive in. Fees charged by a healthcare provider negotiate an individual with a history mastectomy... Is around 4625 ) per affected side for a chart to assist with medical necessity determination for removal!
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