2020 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals
Note: The calendar year deductible applies to almost all benefits in this Section. We say "(No deductible)" when it does not apply.
Section 5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals
Note: The calendar year deductible applies to almost all benefits in this Section. We say "(No deductible)" when it does not apply.
Benefit Description
Reconstructive Surgery
Reconstructive surgical procedures, limited to:
You Pay
Preferred: 30% of the Plan allowance
Non-preferred (Participating/Non-participating): You pay all charges
Reconstructive Surgery
Reconstructive surgical procedures, limited to:
- Surgery to correct a functional defect
- Surgery to correct a congenital anomaly (See Section 10, page 132, for definition.)
- Treatment to restore the mouth to a pre-cancer state
- All stages of breast reconstruction surgery following a mastectomy, such as:
- Surgery to produce a symmetrical appearance of the patient’s breasts
- Treatment of any physical complications, such as lymphedemas
Notes:
- Internal breast prostheses are paid as orthopedic and prosthetic devices; see Section 5(a). See Section 5(c) when billed by a facility.
- If you need a mastectomy, you may choose to have the procedure performed on an inpatient basis and remain in the hospital up to 48 hours after the procedure.
- Internal breast prostheses are paid as orthopedic and prosthetic devices; see Section 5(a). See Section 5(c) when billed by a facility.
- Surgery to produce a symmetrical appearance of the patient’s breasts
- Surgery for placement of penile prostheses to treat erectile dysfunction
You Pay
Preferred: 30% of the Plan allowance
Non-preferred (Participating/Non-participating): You pay all charges
Benefit Description
Not covered:
You Pay
All charges
Not covered:
- Cosmetic surgery – any operative procedure or any portion of a procedure performed primarily to improve physical appearance through change in bodily form – unless required for a congenital anomaly or to restore or correct a part of the body that has been altered as a result of accidental injury, disease, or surgery (does not include anomalies related to the teeth or structures supporting the teeth)
- Surgeries related to sexual dysfunction or sexual inadequacy (except surgical placement of penile prostheses to treat erectile dysfunction and gender reassignment surgeries specifically listed as covered)
- Reversal of gender reassignment surgery
You Pay
All charges
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List Item: |
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reconstructive |
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surgery |
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correct |
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congenital |
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mouth |
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pre-cancer |
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breast |
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mastectomy |
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symmetrical |
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pymphedemas |
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prosthesis |
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orthopedic |
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prostheses |
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prosthetic |
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dysfunction |
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cosmetic |
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inadequacy |
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reversal |
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reassigment |