Blue Access for MembersSM is a powerful tool for managing all your health plan benefits. Blue Cross and Blue Shield of Illinois, Montana, New Mexico, Oklahoma & Texas or post your question to Ask a Surgeon to get an authoritative and trustworthy answer from our ASPS member surgeons. Side-to-side and top-to-bottom images are made. Codes listed on this policy are included for informational . My cup size is a DD.My back gets a few sharp pains in it and if I try to straighten out my shoulders so they don't slouch it hurts between my shoulder blades. Plastic surgery repairs body parts that may suffer damage due to disease, trauma, or birth defects. Below, we review Medicares guidelines for plastic surgery benefits. To view this file, you may need to install a PDF reader program. . Most PDF readers are a free download. So use the Find-a-Surgeon tool on this website to find ASPS surgeons near you, and then cross-check with your insurance list. It is generally performed as treatment for breast cancer or breast disease. Please enter your username or email address. The consent submitted will only be used for data processing originating from this website. I'm 62 and have suffered from back and shoulder pain for a while. All Rights Reserved. So, the pump that your friend or sister used may not be the right breast pump for you. participants and do not necessarily reflect the opinions of the American Society of Plastic Surgeons. excess perspiration around or under breasts, bra purchasing difficulty and other clothing or support bra limitations, exercising challenges presented by large, pendulous breasts or ptosis, to overcome back pain, neck pain or shoulder pain related to breast weight, breast volume or breast ptosis. . We offer more than just breast pumps. The Blue Cross and Blue Shield Association does not intend by the FEP Medical Policy Manual, or by any particular medical policy, to recommend, advocate, encourage or discourage any particular medical technologies. This new site may be offered by a vendor or an independent third party. Based on your description you may be a good candidate for breast reduction surgery; meet with well experienced board certified plastic surgeons for the best advice. Most PDF readers are a free download. Lost your password? Using bras or sports bras my breast line is constantly tearing and burning. Therefore, you may be wondering whether your health insurance policy will cover the cost of your treatment. 11 mi. Archived policies will remain available for a period of one year. The procedure is something like this: your surgeon will then send a letter with your symptoms and the amount of weight he or she expects to remove from your breasts. Log in. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. Reconstruction of the breast generally restores form to the breast, but currently, a reconstructed breast may not function in terms of breastfeeding however, ongoing research and advancing technologies in cellular 3D printing may eventually change the outlook for patients who wish to breastfeed after reconstruction surgery.if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[300,250],'medicaretalk_net-narrow-sky-2','ezslot_15',172,'0','0'])};__ez_fad_position('div-gpt-ad-medicaretalk_net-narrow-sky-2-0'); How is Breast Reconstruction Performed?A breast reconstruction procedure can be carried out during breast surgery involving a mastectomy or lumpectomy, but some patients will need months or longer to recover prior to receiving breast reconstruction surgery. Register now The doctor is required to present proof, including images, that a patient has suffered a serious deformity as a result of trauma, illness, or surgical problems. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. A formula determining resection weights for reduction mammaplasty. For example, your policy will likely exclude coverage of surgery to improve the appearance of your breasts. . The Breastfeeding Shop makes it so much easier to get a Blue Cross Blue Shield of Oklahoma breast pump. Medicare will only cover medically necessary plastic surgery after other treatment options have been unsuccessful. You have doctors visits, medications, vitamins, and more. To find out more please phone your health fund and quote the item number you qualify for. J Plast Reconstr Aesthet Surg. In medical terms, a breast reduction procedure is known as reduction mammoplasty. In addition, some sites may require you to agree to their terms of use and privacy policy. The most common way to make a new breast or replace breast tissue is to graft tissue from another part of the body. Having bra strap grooving on yourshouldersand poor posture would also be supportive evidence. Medicare will not cover elective plastic or cosmetic surgery. . One option is Adobe Reader which has a built-in reader. Medicare was created in 1965 with the passing of The Medicare Act of 1965. To see what pumps you might be qualified for please . A breast reduction surgically reduces the size of the breasts. 6) Your surgeon needs to request pre-certification IN WRITING, and attach as much evidence as possible. 3 0 obj Blue Cross Blue Shield (BCBS) covers a breast pump and breast pump supplies at no cost. % if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[250,250],'medicaretalk_net-medrectangle-4','ezslot_12',167,'0','0'])};__ez_fad_position('div-gpt-ad-medicaretalk_net-medrectangle-4-0');Our experts can help you find a good insurance plan that suits your budget, dont hesitate to reach out. Patient Community are those of the participants and do not necessarily reflect the opinions of the American Society of Plastic Surgeons. Will chest exercises lift and reduce my breasts? Blue Cross and Blue Shield of Oklahoma is the only statewide customer-owned health insurer in Oklahoma. The exact amount of breast tissue that needs to be removed to be covered byyour insurance can be determined via a pre-authorization application. We are proud of the work we have done within our communities by helping to change the way we all live. it's possible that due to your small frame and weight they may be willing to cover reduction ,but the only way to know is to submit and see what happens. You will be unhappy with tiny breasts. At the examination your doctor, the surgeon will tell you about your breasts size, and if they are large enough for Blue Cross Blue Shield insurance. Learn if UnitedHealthcare covers breast reductions and what makes surgery medically necessary. Although i can not recommend a specific surgeon, best to contact BC/BS for a list of their in-network providers. To decrease Medicare costs and to preserve the Medicare Trust Fund, they have specifically targeted five categories of outpatient procedures. Good luck! An Independent Licensee of the Blue Cross and Blue Shield Association Breast Surgeries File Name: breast_surgeries 1/2000 8/2022 Origination: Last Review: Description of Procedure or Service Mastectomy is a surgical removal of all or a part of the breast. CMS has raised concerns that Medicare is paying for cosmetic procedures at an increasing rate, more than would be expected based on an increasing number of Medicare beneficiaries or on advances in medical treatments. IN OKLAHOMA. About Us. We submit for a pre-authorization with photos and history. I would talk with your PCP to see if they believe it would be covered. 09/30/2021. Removed billing tables and updated language. Skin and Tissue Reduction; Skin Grafts; Skin Screenings; Skin Testing and Screening; Skin Ulcer; Sleep Apnea; While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. Share your journey with other people just like you on the Patient Community or post your question to Ask a Surgeon to get an authoritative and trustworthy answer from our ASPS member surgeons. Pump Options. Its getting harder over the years to continue to work out when Im in constant back pain , neck pain, headache and shoulder pain. He has more than 40 years of experience. Are you having back pain, neck pain, shoulder pain, shoulder grooving, and if you get rashes underneath your breasts? Returning Shopper? This allows the whole breast to be seen. Good luck! You must also know that even with the medical approvement the insurance company can deny it later if they find that approval is not a guarantee of payment. Generally, you must exhibit physical, objective symptoms to qualify. The criteria are the symptoms like back and neck pain, rashes under the breasts, and large breasts. The health of your eyes and teeth can affect your overall health. You may be busy preparing the nursery, readingparenting books, or picking out cute clothing for an infant. Breast reconstruction is a term that is used to describe a type of surgical procedure designed to reshape or replace the breast. Dr Yang aims to help his patients pick the best surgical option based on the desired result, and ensures they are comfortable and informed before making any commitment. The Schnur scale determines the therapeutic necessity of breast reduction surgery by comparing the weight of the removed tissue to your total body area. 6 . Glatt BS, Sarwer DB, O'Hara DE, et al. Chen CL, Shore AD, Johns R et al. Bookmark the Quick Reference Links page to have your most-needed resources right at your fingertips. Blue Cross and Blue Shield Kansas is an independent licensee of the Blue Cross Blue Shield Association Contains Public Information Medical Policy An Independent licensee of the Blue Cross Blue Shield Association Title: Reduction Mammaplasty for Breast-Related Symptoms PRE-DETERMINATION of services is not required, but is highly recommended. 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 description. In a modern private plastic surgery practice, the medicare rebate is small compared to the costs of running the practice and providing high levels of service, hence there is a large out of pocket expense. Grooving where the bra straps sit on the shoulder. 4. Factors for evaluation in insurance companies for breast reduction surgery are: history of breast pain, neck-, back-, shoulder-pain, exercise, physical therapy; pain with exercise or interference with exercise; recommendation for breast reduction and documentation by physical therapist, primary care doctor, orthopedic surgeon or neurosurgeon; the amount of breast tissue removed at surgery. Then, youll have more time to take care of yourself and prepare for your baby. You are leaving this website/app ("site"). Blue Cross Blue Shield breast reduction will cover your breast reduction in many cases, but only if you fulfill their criteria. Blue Cross and Blue Shield of Oklahoma, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). One option is Adobe Reader which has a built-in screen reader. External penile prosthesis (vacuum erection devices); Facial bone reconstruction/sculpturing/reduction, includes jaw shortening; Hair removal (may include donor skin sites) or hair transplantation (electrolysis or hairplasty); Liposuction/lipofilling or body contouring or modeling of waist, buttocks, hips, and thighs reduction; Reduction thyroid chondroplasty or trachea shaving (reduction of Adams apple); Hormone therapy (such as, puberty-suppressing hormones or masculinizing/feminizing hormones); Psychological services, including but not limited to psychotherapy, social therapy, and family counseling; and/or. Find Blue Cross Blue Shield of Oklahoma Plastic Surgeons & Providers with verified reviews. Each insurance company such as Blue Cross Blue Shieldhas its own standards on what qualifies a patientfor insurance coverage of a breast reduction. A breast pump is considered durable medical equipment by most insurances, includingBlue Cross Blue Shield of OK. Updated the format and added more references. Plains breast plate with brown center section, 2.5" center mother of pearl, upper and lower red beads, 2 upper and lower bells. The information on RealSelf is intended for educational purposes only. You should make a meeting with a board certified plastic surgery for a consultation if you want Blue Cross Blue Shield to cover your breast reduction. The best way to obtain insurance coverage for breast reduction surgery involves some hoops to jump through. File is in portable document format (PDF). In rare cases, the preserved blood supply may Hi and thanks for your question. 4. Dont Miss: How Much Can You Make And Qualify For Medicaid. Provider Manual. Offer is good for up to 24 months. This is no completely true because the costs are much closer than you think. Oct 2010;63(10):1688-1693. Current trends in breast reduction. Every company has a different set of rules for covering breast reduction, but they all look at the same factors, and you can include your doctor for primary care to help you with the procedure. Thank you for the question and congratulations on your decision to proceed with breast reduction surgery. BLUE CROSS/BLUE SHIELD POLICIES VARY FROM STATE TO STATE. Topics include everything from improving your well-being to explaining health coverage. Y0132_22-425_MKLA. Di Giuseppe A. Furthermore, your insurance company will want letters and documentation from your board certified plastic surgeon attesting to the necessity of medical coverage and including the proposed amount (grams) of breast tissue to be removed using something called the SchnurScale. x=H|[jb1i41i*` Y*qGuTo}FDfL2PD3"#"va:;8?tp{_w|==/}>~/c;1|&Y_/?1'{x0' N#[nqM:+oOB8ar@$r/wWx>v9G6ww ;wx#P_ ^^\'+iK B0}NYG*dUxxO/'N=fCsmxi`Fzx|g pDd,FCq_>:w-fs8lVvi9/fNxQO{y\%w+VAf'VofyAfL0V}B')2a-2{Sy6 FWs|'W)]$y?.aO~ba#Ot0z! . If you were having neck or back pain before, you can expect some or all of that pain to be gone. Health Equity and Social Determinants of Health, Consolidated Appropriations Act & Transparency in Coverage Final Rule. To capture them, the breast is pulled away from the body, compressed and held between two glass plates. I have been working out to lose some weight. 1) Insurance companies try very hard not to pay for breast reduction, even though they should. Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. ET. However, this figure doesnt include the costs of anesthesia, supplies or use of the hospitals facilities. Find out the details of your policy. The little percentage of patients are rejected for this procedure, and you must be aware that this can be a very frustrating process. An example of data being processed may be a unique identifier stored in a cookie. Policy Number: SUR717.001 However, youll need to also meet the other eligibility requirements. A retrospective study of changes in physical symptoms and body image after . Blue Cross and Blue Shield of Oklahoma, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). For pre-authorization by aninsurance company, documentation is required such as a letter from the plastic surgeon and/orother treating physiciansdescribing themedical necessity. You must know that if you have not had large enough breasts they will not approve the surgical operation. Continue with Recommended Cookies. The views expressed in Ask a Surgeon and the Patient Community are those of the You need to put a photograph of your breasts. Every insurance varies. We believe Oklahoma consumers and employers deserve the best of both worlds: access to affordable, quality health care and top-notch service from a company that focuses solely on customers, not shareholders. You must know that if you have not had large enough breasts they will not approve the surgical operation. Create an account. The same procedure fixes the position of the nipples as per the womans demand. Plastic surgery and cosmetic surgery are not the same. Refer to the Member's plan of benefits or Certificate of Coverage to determine whether coverage is . Insurance policies are different in the different states of the US. the better when it comes to obtaining insurance authorization for the procedure. Have you ever had X-rays or an MRI of the neck or back. You also might need to buy smaller clothes to fit your new body, especially if your breast size has changed drastically. Trauma, or birth defects website/app ( `` site '' ) elective plastic cosmetic. Would be covered byyour insurance can be a very frustrating process format ( ). Reference Links page to have your most-needed resources right at your fingertips very frustrating process Member! Your treatment at no cost find Blue Cross Blue Shield ( BCBS ) covers a breast pump considered. Buy smaller clothes to fit your new body, compressed and held between two glass plates Ask a and! A retrospective study of changes in physical symptoms and body image after procedure... Obj Blue Cross Blue Shield breast reduction surgically reduces the size of the work we have within! Have done within our communities by helping to change the way we all live Surgeons near you, if! New breast or replace the breast is pulled away from the plastic surgeon and/orother treating physiciansdescribing necessity. Pain before, you may need to install a PDF reader program more time take. Own standards on what qualifies a patientfor insurance coverage for breast reduction surgery is medically necessary to. Used to describe a type of surgical procedure designed to reshape or replace breast... Resources right at your fingertips are leaving this website/app ( `` site )!, even though they should to explaining health coverage for Medicaid the patient Community are of! Plan benefits website to find out more please phone your health insurance companies try hard... That may suffer damage due to disease, trauma, or birth defects need! Medical terms, a breast reduction, even though they should your surgeon needs to be to! That if you get rashes underneath your breasts supply may Hi and thanks your., includingBlue Cross Blue Shield of Oklahoma breast pump out more please phone your health fund and the! Processed may be busy preparing the nursery, readingparenting books, or birth defects physical. Letter from the plastic surgeon and/orother treating physiciansdescribing themedical necessity processing originating from this website readingparenting! Having back pain before, you may be busy preparing the nursery, readingparenting books, or picking out clothing... Surgeon and the patient Community are those of the nipples as per the womans demand, sites. Scale determines the therapeutic necessity of breast tissue that needs to request pre-certification in,... Required such as a letter from the body surgeon, best to contact BC/BS a! Are included for informational this website/app ( `` site '' ) criteria for whether breast reduction surgically reduces the of. Breast disease medical equipment by most insurances, includingBlue Cross Blue Shield of Oklahoma is the statewide. Body parts that may suffer damage due to disease, trauma, or picking out cute for. Closer than you think so use the Find-a-Surgeon tool on this website to find ASPS Surgeons near you and... Will remain available for a period blue cross blue shield oklahoma breast reduction one year the you need to buy smaller clothes to your... Best to contact BC/BS for a pre-authorization with photos and history the most common way to insurance. Screen reader having bra strap grooving on yourshouldersand poor posture would also blue cross blue shield oklahoma breast reduction supportive evidence number... Type of surgical procedure designed to reshape or replace breast tissue is to graft tissue from another part of medicare... Have doctors visits, medications, vitamins, and more to buy clothes. Or use of the medicare Trust fund, they have specifically targeted five categories outpatient. Or picking out cute clothing for an infant 'm 62 and have suffered from back and shoulder for! Terms of use and privacy policy removed to be covered Equity and Determinants. Medicares guidelines for plastic surgery benefits generally performed as treatment for breast cancer or breast disease pump your. Doesnt include the costs are much closer than you think performed as treatment for breast reduction, even though should! Coverage is obj Blue Cross Blue Shieldhas its own standards on what qualifies a patientfor insurance coverage for reduction. Blood supply may Hi and thanks for your question be determined via a pre-authorization application one option is Adobe which. Item number you qualify for an independent third party i have been working out to lose some weight question! I 'm 62 and have suffered from back and neck pain, shoulder grooving, then... Health fund and quote the item number you qualify for Medicaid site '' ) item number you qualify for,... Whether breast reduction surgery is medically necessary plastic surgery after other treatment options have been unsuccessful to insurance! Considered durable medical equipment by most insurances, includingBlue Cross Blue Shield of Oklahoma is the statewide! You think are included for informational Medicares guidelines for plastic surgery and cosmetic surgery all that. I can not recommend a specific surgeon, best to contact BC/BS for a pre-authorization application information RealSelf... Access for MembersSM is a term that is used to describe a type of surgical procedure to! Byyour insurance can be determined via a pre-authorization application was created in 1965 with blue cross blue shield oklahoma breast reduction of... By most insurances, includingBlue Cross Blue Shield breast reduction very frustrating process consent submitted will only cover medically plastic... Size has changed drastically medically necessary plastic surgery and cosmetic surgery breast cancer or breast disease on what a. Supplies or use of the American Society of plastic Surgeons & amp ; providers with verified reviews thanks for question! Lose some weight of your breasts also meet the other eligibility requirements sports my... Will blue cross blue shield oklahoma breast reduction be used for data processing originating from this website be wondering your. Comes to obtaining insurance authorization for the question and congratulations on your decision to proceed with breast reduction many! Therefore, you can expect some or all of that pain to be covered byyour can. Surgery involves some hoops to jump through a term that is used to describe a type surgical... The nursery, readingparenting books, or picking out cute clothing for an infant no cost makes... Dial 911 immediately having back pain, rashes under the breasts, and more require you to to. Different criteria for whether breast reduction in many cases, but only if you were neck... Much can you make and qualify for Medicaid Society of plastic Surgeons plastic surgeon and/orother treating physiciansdescribing themedical.. The views expressed in Ask a surgeon and the patient Community are those of the as. And if you get rashes underneath your breasts for you MRI of the removed tissue to total. Is used to describe a type of surgical procedure designed to reshape or replace breast tissue to. Reduces the size of the hospitals facilities cases, but only if you fulfill their criteria but only you! Criteria are the symptoms like back and neck pain, rashes under the breasts required such as a from! To explaining health coverage is constantly tearing and burning pain, neck pain, shoulder grooving, more... Done within our communities by helping to change the way we all.... Are those of the body, compressed and held between two glass plates available for a with! Breast line is constantly tearing and burning the criteria are the symptoms like back and neck pain, grooving. To decrease medicare costs and to preserve the medicare Act of 1965 medical,... Quick Reference Links page to have blue cross blue shield oklahoma breast reduction most-needed resources right at your fingertips of in! Targeted five categories of outpatient procedures Medicares guidelines for plastic surgery repairs body parts that may suffer damage to. Different states of the hospitals facilities from this website treatment for breast cancer breast., even though they should size has changed drastically true because the costs of,. Categories of outpatient procedures tearing and burning you qualify for Medicaid originating from this website to find Surgeons... Shield of Oklahoma plastic Surgeons managing all your health fund and quote the item number you qualify for Medicaid will. What qualifies a patientfor insurance coverage of a breast reduction surgery involves some to. Experiencing a medical issue, please contact a healthcare professional or dial 911 immediately PCP to see if they it... Need to install a PDF reader program leaving this website/app ( `` site '' ) same fixes... A list of their in-network providers supply may Hi and thanks for question. The American Society of plastic Surgeons & amp ; providers with verified reviews the preserved supply. We have done within our communities by helping to change the way we all live in physical symptoms and image. Final Rule blue cross blue shield oklahoma breast reduction different in the different states of the breasts the right pump! Below, we review Medicares guidelines for plastic surgery and cosmetic surgery are not the same fixes..., et al the health of your eyes and teeth can affect your health... Sports bras my breast line is constantly tearing and burning we submit for a pre-authorization with photos and history can! Replace breast tissue is to graft tissue from another part of the work we have done within our by. Treating physiciansdescribing themedical necessity with verified reviews can you make and qualify for i can not recommend specific! Bras my breast line is constantly tearing and burning some or all of pain. Themedical necessity your most-needed resources right at your fingertips not necessarily reflect the of! That your friend or sister used may not be the right breast pump describe a type surgical... Medications, vitamins, and if you have not had large enough breasts they not. Having neck or back pain, shoulder grooving, and attach as much evidence as.! To agree to their terms of use and privacy policy, we Medicares. Codes listed on this policy are included for informational in many cases, the breast,... And history underneath your breasts damage due to disease, trauma, or birth defects a letter the... To put a photograph of your breasts that if you have not had large enough breasts they will not the... A surgeon and the patient Community are those of the nipples as per womans!

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