Dr. Schaffner is out of network for all insurance carriers except some plans for UnitedHealthcare/Oxford, MagnaCare and Medicare (not Medicare Advantage Plans). Dr. Moustafa Mourad, MD, FACS is a distinguished, New York City based Facial Plastic and Reconstructive surgeon. I have BCBS and am waiting for them to approve or deny my pre-approval for Explant due to grade 4 Capsular Contracture and a rupture. I see specialists constantly, have to take a handful of meds daily, and receive IVG infusions 4x monthly. Thank you for your questions and photos. T85.43XA Rupture of Breast Prosthesis He is now in private practice, seeking to give the highest quality care in a more personalized setting. This website can be reached by comment or email ([emailprotected]), your feedback is warmly welcomed. Do not get discouraged, one woman reapplied three times and then was approved. Breast implants are prosthetic devices used to augment, reshape, and/or reposition a woman's . Feels foolhardy to go into something as invasive as enbloc removal without a physicians blessing and confirming diagnostics. Insurance companies would save on years or decades of unnecessary medical costs by recognizing the necessity of explant surgery as a cost effective protocol to prevent further systemic illness. February 27, 2023 . Painful capsular contracture with disfigurement, Source: https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=35163&ver=13&SearchType=Advanced&CoverageSelection=Local&ArticleType=SAD%7cEd&PolicyType=Both&s=6&KeyWord=breast+implant&KeyWordLookUp=Doc&KeyWordSearchType=Exact&kq=true&bc=IAAAACAAAAAA&. Doctors listened until I connected the dots and started suggesting that my symptoms might be related to the implants. One of them was ruptured and the other one was intact. Add your insurance to see in-network doctors. The Women's Health and Cancer Rights Act of 1998 requires all group health plans that pay for mastectomy to also cover prostheses and reconstructive procedures. After medical school, Dr. Kwak moved to New York City for his post graduate medical training. Dr. Bartsich also offers the no-implant lift, which uses the patient's own breast tissue to create cleavage without an implant, and the Reduction Revolution that rebalances women with large breasts and frees them of their bras. Went to sergeon and I have a capsulary contractors. Breast pumps, except as described on page 48 ; Communications equipment, devices, and aids (including computer equipment) such as . TheNational Center for Health Researchis a nonprofit organization assisting women who seek health insurance coverage or Medicare coverage for the medically necessary removal of theirbreast implants. Blue Cross and Blue Shield Kansas is an independent licensee of the Blue Cross Blue Shield Association Contains Public Information POLICY A. If you need further surgery. Zocdoc only allows patients to write reviews if we can verify they have seen the provider. does blue cross blue shield federal cover breast augmentation. He has written a media-reviewed childrens book for children suffering from cleft lip and palate deformities and the family members who take care of them. Dr. Mourad was then selected from hundreds of exceptional candidates to complete an additional year of aesthetic and advanced facial plastics and reconstructive surgery training with the world-renowned surgeon Dr. Yadranko Ducic. He currently serves in several high-profile positions. My symptoms began immediately but were small enough to dismiss and attribute to something else. An independent licensee of the Blue Cross Blue Shield Association Discrimination is Against the Law Premera Blue Cross (Premera) complies with applicable Federal and Washington state civil rights laws and does not discriminate on the basis of race, color . Covered Services Blue Cross and Blue Shield of Texas (BCBSTX) gives health care benefits and access to care to help your child stay well. Unfortunately, the BCBS coverage is primarily offered only for panniculectomy to address medical concerns occurring because of excess . He works in association with multiple hospitals such as Lenox Hill Hospital, Northern Westchester Hospital, New York Brooklyn Methodist Hospital, and the Manhattan Eye, Ear & Throat Hospital. I have started to have acute breast pain in one breast only associated with some numbness, implant looks flat from up top and small lump on side of breast, my plastic surgeon says is probably cystic fibroma which I never had till a week ago. He explains carefully and clears the patients mind.". Description Mastectomy is the removal of all or part of a breast and is typically performed as a treatment for cancer, or in some cases for the treatment of benign disease. The reason we can't 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, you'll have to consult your plan's list of covered benefits to determine how much, if any, your insurance company will pay toward this procedure. Ive been diagnosed with stiff persons syndrome,neurothapy, gastroparesis, auto immune disease, depression,anxiety, and the list goes on and on. Dear Geneseo,Thank you for your post. (or any amounts you desire). See page 2 of Cigna Medical Coverage Policy 0048 for coverage criteria: Mechanical complication of breast prosthesis; including rupture or failed implant, and/or implant extrusion. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. C84.79 Anaplastic large cell lymphoma, ALK-negative, extranodal, solid organ sites N63 Unspecified lump in breast, nodule, mass, or swelling of the breast "Very professional, and knowledgeable. Some insurances have added coverage for removal of Allergan Biocell textured breast implants and tissue expanders after the global recall (Class I recall in the US) due to risks of BIA-ALCL. But more than that, his bedside manner is one of the best of any physicians I have ever been to. dont know how but I have to my life depending on it. Dr. Shafqat has been published in several of the top journals in plastic surgery as well as having his work presented at local, regional, and national plastic surgery meetings. Based on that information, youll see a list of providers who meet your search criteria, along with their available appointment slots. Medical necessity for diagnostic breast MRI can be demonstrated by meeting one or more of the following criteria: a. to detect an occult malignancy of the contralateral breast in a member with a new breast malignancy; b. Any and everything, that couldnt be explained. T85.848A Pain due to internal prosthetic devices, implants and grafts Ive gone from being a total social butterfly, to more of a hermit who just wants to be home laying In bed at all times. He has also authored numerous journal publications in his field of specialty and has given many presentations at professional society meetings. were you ever able to and if so how you went about it to have blue cross cover your implant extraction. does blue cross blue shield federal cover breast augmentationsmith and wesson model 19 classic problemssmith and wesson model 19 classic problems Are you able to share the name of the physician you consulted with in CO? I serve as the Chief of Plastic and Reconstructive Surgery at Mount Sinai Elmhurst Hospital after completing two specialty fellowship programs: a reconstructive microsurgery fellowship specializing in aesthetic and reconstructive breast surgery at Lenox Hill Hospital, and a Lymphedema surgery fellowship program at Memorial Sloan Kettering Cancer Center. Due to the importance of our work and the hundreds of women we have been able to help over these past few years, we have secured new funding to continue our project so that we can assist hundreds of more women in navigating the health insurance process for breast implant removal. She was initially denied disability so she started a lawsuit. He is board-certified by the American Board of Otolaryngology Head and Neck Surgery, one of the oldest medical specialties in the country. "After many years of struggling with the decision to undergo breast surgery, I finally felt ready under the care of Dr. Shridharani. implant is not covered if the implant was originally cosmetic in nature. Optional: Upload attachment(Allowed file types: jpg, gif, png, pdf, maximum file size: 8MB. Is there any finical help of any kind out there??? Took his time with me.". Reduction mammaplasty is a surgical excision of a substantial portion of the breast, including the skin and underlying glandular tissue, that is designed to remove a variable proportion of breast tissue to address emotional and psychosocial issues and/or to relieve the associated clinical symptoms. Depression, anxiety, mood swings, bi-polar outbreaks, nausea all the time. Medical Policy Information for Out-of-Area Members. Dr. Lefkovits attended medical school at Georgetown University School of Medicine and Downstate Medical Center. reconstructed breast. (b) Notice. Both implants were explanted due to medical necessity: capsular contraction, pain and rupture as confirmed via MRI. Im in such pain and need to find a way to have my implants remove. Blue Cross Blue Shield: AZ, FL (covered 90%), MI, MN, NM, NY, OK, WA, CA. Washington - Today the Blue Cross and Blue Shield (BCBS) Government-wide Service Benefit Plan, also known as the Federal Employee Program (FEP), introduced FEP Blue FocusSM, a new coverage option for the federal workforce and retirees in the Federal Employees Health Benefits (FEHB) Program. Pain: In general, breast augmentation is tolerated very well. So after insurance i will owe 42,000.00. Same here..BCBS of Illinois, but I live in Texas. Thanking anyone in advance for guidance. [emailprotected], I know my breast are infected and its fungus from mold and I take everything I can to keep it killed but it never is enough its a rose fungus and its growing in my breast I need help 58 year old disabled grandmother of 6, Does anyone here have Tricare insurance or heard of someone getting the Explant covered by Tricare? In addition to his attention to detail, he is passionate about helping all his patients leave his office feeling confident about their procedure and positive about their outcome. The entire situation was tailored to making me feel comfortable, which is not always the case in a plastic surgeons office. I am a New York Licensed and an Israeli Board Certified Plastic Surgeon. In other words, insurance cannot legally deny coverage for prosthetics, mastectomy bras, and accessories that may or may not be needed after the surgery. I recommend him to anyone looking for a great Dr.". Then I was in an accident , the airbag deployed and had made my health even worse . In addition, he has additional training and expertise in reconstruction, complex cosmetic and reconstructive breast surgery, revisional breast surgery, skin cancer reconstruction, and hernia repairs. I feel absolutely decrepit! Fatigue, depression , weight issues , body aches.. the list goes on.. Procedure Codes Canthopexy may be considered medically necessary when performed for ANY ONE of the following conditions: Presence of corneal or conjunctival staining; or Mucous membrane changes; or Whether the surgery is to be inpatient or outpatient and the length of stay are decisions for the . Very friendly & knowledgeable. does blue cross blue shield federal cover breast augmentation. Patients visit him for a wide spectrum of common and specialized medical needs, including, anti-aging treatments, facelift, liposuction, skin lesions, and jaw malformations. 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