Does blue cross blue shield cover double mastectomy

You will likely need to stay in the hospital for at least 1 night after mastectomy. It depends on your overall health, how you feel after surgery, and your doctor's practices.

1. You'll be asked to remove your clothing and given a gown to wear.

2. An IV (intravenous) line will be started in your arm or hand. You'll be given medicine through the IV. This will help you relax and put you into a deep sleep during the surgery so you don't feel pain.

3. You will lie on your back on the operating table.

4. Your heart rate, blood pressure, breathing, and blood oxygen level will be watched closely during the surgery.

5. The skin over your chest will be cleaned.

6. A cut (incision) will be made in your breast. The type of cut and where it is depends on the type of mastectomy you have.

7. The surgeon will gently cut free and remove underlying tissue.

8. Lymph nodes might be removed after the breast or breast tissue has been removed.

9. If you 're having breast reconstruction along with the mastectomy, a plastic surgeon will do the reconstruction after the mastectomy.

10. Breast tissue and any other tissues that are removed will be sent to the lab for testing.

11. One or more drainage tubes may be put in the breast to keep fluid from building up as the area heals.

12. The skin will be closed with stitches, glue, or adhesive strips.

13. A sterile bandage or dressing will be placed over the site. A stretchy band will be wrapped around your chest. This will stay on for a few days.

    Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; reconstructive procedures on breast (e.g., reduction or augmentation mammoplasty, muscle flaps)

    00404

    Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; radical or modified radical procedures on breast

    00406 Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; radical or modified radical procedures on breast with internal mammary node dissection 11920

    Tattooing, Intradermal Introduction of Insoluble Opaque Pigments to Correct Color Defects of Skin, including Micropigmentation; 6.0² cm or less

    11921

    Tattooing, Intradermal Introduction of Insoluble Opaque Pigments to Correct Color Defects of Skin, including Micropigmentation, 6.1 to 20.0²cm

    11922

    Tattooing, Intradermal Introduction of Insoluble Opaque Pigments to Correct Color Defects of Skin, including Micropigmentation; each

    11970 Replacement of tissue expander with permanent prosthesis 11971 Removal of tissue expander(s) without insertion of prosthesis 15271

    Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

    15272

    Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)

    15777

    Implantation of biologic implant (e.g., acellular dermal matrix) for soft tissue reinforcement (i.e., breast, trunk) (list separately in addition to code for primary procedure)

    15877

    Suction assisted lipectomy; trunk

    17999

    Unlisted procedure, skin, mucous membrane and subcutaneous tissue

    19316

    Mastopexy

    19318  Reduction mammaplasty 19324

    Mammaplasty, Augmentation; Without Prosthetic Implant

    19325

    Mammaplasty, Augmentation; With Prosthetic Implant 

    19328 Removal of intact mammary implant  19330 Removal of mammary implant material  19340

    Immediate Insertion of Breast Prosthesis Following Mastopexy, Mastectomy or Reconstruction 

    19342

    Delayed Insertion of Breast Prosthesis Following Mastopexy, Mastectomy or In Reconstruction

    19350

    Nipple/Areola Reconstruction 

    19355  Correction of inverted nipples  19357 

    Breast Reconstruction, Immediate or Delayed, With Tissue Expander, Including Subsequent Expansion 

    19361 

    Breast Reconstruction with Latissimus Dorsi Flap without Prosthetic Implant 

    19364 

    Breast Reconstruction with Free Flap 

    19366 

    Breast Reconstruction with Other Technique 

    19367 

    Breast Reconstruction with Transverse Rectus Abdomins Myocutaneous Flap (Tram), Double Pedicle, Including Closure of Donor Site 

    To help you find that information quickly and easily, we put together this summary1explaining how our health insurance works, with additional information about Blue Cross NC Quality Improvement programs.

    The Member's Rights and Responsibilities

    Helpful Information

    Notice of Mastectomy Benefits

    As required by the Women's Health and Cancer Rights Act of 1998, your health insurance policy provides benefits for mastectomyrelated services, including all stages of reconstruction and surgery to achieve symmetry between the breasts, prostheses and complications resulting from a mastectomy, including lymphedema. This coverage is subject to the same deductibles, copayments, coinsurance or limitations as applied to other medical and surgical benefits provided under your policy. If you have questions, please check your benefit booklet or call the Customer Service number on your ID card for more information.

    Continuity of Care

    At Blue Cross NC, when you change health plans or your doctor* is no longer part of the Blue Cross NC network, you may be eligible to get continued care from your doctor for a short time. During that time, you and your doctor should look for a new, in-network doctor for your care. Blue Cross NC will help its members who need continued care during a change in coverage. This process is called "continuity of care."

    To be eligible for continuity of care, one of these four conditions must apply:

    • You have a short-term health problem that is life-threatening and needs continued care from your doctor to prevent a chance of death or permanent harm.
    • You have a long-term health problem that is life-threatening, degenerative or disabling and need continued care over a longer time.
    • You are pregnant or completing post-partum care.
    • You have a terminal illness, which means a medical prognosis that puts your life expectancy at six months or less.

    You must send a request to Blue Cross NC for continuity of care. A Blue Cross NC nurse will review your request. You can call Customer Service at the phone number on the back of your ID card and ask for a continuity of care request form. Your doctor also has to agree to Blue Cross NC's rules for continued care.

    If you are new to Blue Cross NC, you must send the form in within 45 days of your effective date.

    If you are not a new member and have learned that your doctor is not in the Blue Cross NC network, you must send the form in within 45 days from when you found out your doctor was out of Blue Cross NC's network.

    ---

    * Doctor may also mean a nurse practitioner, physician assistant or other health care expert that you have seen for health care.

    Transitioning from Pediatric to Adult Care

    For teenagers and young adults, it can be tough to know when to switch from their childhood doctor to one who specializes adult care. Most choose to make this transition around 18 to 21 years of age. Blue Cross NC can help members find an in-network doctor near them who is qualified to care for adults. If you are a pediatrician, you can also help your teenage and young adult patients transition to a primary care provider for adults.

    Contact Information

    • Online: Blue Connect
    • Access to utilization management review staff:
      1-800-672-7897 (toll free)
    • Blue Cross NC Customer Service:
      1-800-446-8053 
      8 a.m. – 9 p.m., Monday – Friday
    • Join our provider email registry to get the latest news from Blue Cross NC.
    1. In the event of any inconsistency between information contained in this summary and the member's Benefit Booklet, the Benefit Booklet shall govern.
    2. The Benefit Booklet defines an adverse benefit determination as follows: A denial, reduction or termination of, or failure to provide full or partial payment for, a benefit, including one that results from the application of any utilization review, or a failure to cover an item or service for which benefits are otherwise provided because it is determined to be experimental or investigational or not medically necessary or appropriate. Rescission of coverage is also included as an adverse benefit determination.

    The National Committee for Quality Assurance (NCQA) is an independent, not-for-profit organization that evaluates and reports on the quality of the nation's managed care plans. NCQA maintains and regularly updates quality standards utilized by the health insurance industry to gauge levels of ongoing quality and improvement. The NCQA accreditation program helps employers and consumers compare health plans based on various quality measures.

    Can you request a double mastectomy?

    Don't be afraid to discuss the possibility of a double mastectomy with your surgeon. He should be able to tell you whether or not this is the right procedure for you. Your cancer nurse is correct, most of us feel very emotional, nervous and anxious until we know exactly what we are dealing with.

    Are you cancer free after a double mastectomy?

    Even if the full breast is removed, surgeons will not have removed 100% of the breast cells, explains Jessica Young, MD, a breast surgeon at Roswell Park. The risk of cancer recurring is lower if the whole breast is removed, but it is not zero percent.

    Why would a doctor recommend a double mastectomy?

    Double mastectomy is sometimes done as a risk-reducing (or preventive) surgery for women at very high risk for getting breast cancer, such as those with a BRCA gene mutation. Most of these mastectomies are simple mastectomies, but some may be nipple-sparing.

    How long is hospital stay after double mastectomy?

    The surgery usually involves a short hospital stay of 1 to 3 days and a follow-up in 1 to 2 weeks, but it may be longer if your procedure is more complex, or if you also opt for immediate reconstructive surgery. You also have an option for a delayed reconstruction or no reconstruction at all.