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Two new policies on breast reconstruction surgery

Our new advance patient notice policy (starting July 1) asks breast surgeons in our network to provide more information if they refer you to a breast reconstruction surgeon who is not in our network. The doctor will need to fill out the new Advance Patient Notice for Use of an Out-of-Network Breast Reconstruction Surgeon Form and share it with you. You will have to sign to acknowledge receipt of the form and your doctor will keep a copy on file.

If you're a member about to get this type of surgery, please go over this form with your doctor — so you can make an informed choice about your care. Your doctor will also give you a copy of our new Out-of-Network Exception Requests for Breast Reconstructive Surgery Following a Mastectomy Policy.

This exception policy may not apply to your employer benefit plan that is administered by Empire. It does not apply to:

  • Medicare Advantage plans
  • FEP plans
  • Services received through the BlueCard program

If you have questions about whether this applies to your plan, please call the member services number on your ID card.

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