blue cross blue shield mammogram coverageblue cross blue shield mammogram coverage

Health plans are offered by Blue Shield of California. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography (e.g., extremely or heterogeneously dense breasts, implants); A breast cancer risk assessment (by the Gail risk or other validated breast cancer risk assessment models) that identifies the individual as having a lifetime risk of 20% or greater of developing breast cancer (approve annually); Two (2) or more first degree relatives (parents, siblings, and children) have history of breast cancer; Individuals with histories of extensive chest irradiation (usually as treatment for Hodgkin's or other lymphoma.) Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Make sure to get all the screenings and vaccines recommended for your age and gender. Check out the changes and updates to our plan in 2023. HMO Scope of Benefits Section . Coverage is subject to the specific terms of the member's benefit plan. Learn more about our non-discrimination policy and no-cost services available to you. Select a Region: Please Select One DVEST1 DV9ST1 DV8ST1 DV5ST1 DV4ST1 DV1ST1 DVPST1 DVOST1 DVMST1 DVJST1 DVHST1 DVGST1 DVFST1 DVEST1 DVDST1 DVCST1 LOEST1 Should a member request Provider Manual . This can get confusing, so call your health plan before you go. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. No lump, no cancer. Recommended repeated Rh (D) antibody testing for all unsensitized Rh (D)-negative women at 2428 weeks gestation unless the biological father is known to be Rh (D)-negative, Anesthesia services will pay at 100% only for sterilization, Certain services for contraceptive device insertion and removal, such as ultrasounds to confirm IUD placement, will pay at 100%, Pregnancy tests prior to the initiation of contraceptive will pay at 100%. The site may also contain non-Medicare related information. You are only exposed to a small amount of radiation during a mammogram, and studies show that the benefits of mammograms outweigh any risks. *Applicable Wellness Screenings: $50 benefit paid one time per year, per insured (age 18 and over) for breast ultrasound, breast MRI, mammograms, CA 15-3 . Necesita su ID de usuario? Who can physicians call if they have questions? Blue Cross NC has partnered with American Imaging Management, Inc. (AIM) for the management of outpatient, high-tech diagnostic imaging services. How long is an authorization of a diagnostic imaging procedure valid? We apologize for any inconvenience. As always, be sure to check your specific plan coverage and see an in-network provider. What is a Religious Organization:A religious organization refers to all employer groups defined under federal law that may limit or not cover contraceptive services due to the type of organization or that have a religious objection to these services. Pays cash if you're treated for cancer. Returning Shopper? 0 The goal of the diagnostic imaging program is to improve affordability of health care to Blue Cross NC members. Privacy Policy Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : mammograms. These benefits are currently in effect unless otherwise noted. Blue Cross and Blue Shield of Illinois . But Humana, which I have now, is even worse because I have a $50 copay just for screening." 3. If so, it should not impact the ability of members to receive these tests. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. Are you going to reimburse providers for the savings Blue Cross NC will incur? Mammograms are one of the best ways to find it early. Breast Cancer and Early Detection: What Women Need to Know. Click on a service to see any limits or exclusions. Most basis mammogram screenings are covered by your health plan. Necesita su ID de usuario? Your doctor will help you decide what schedule makes the most sense for you. Am I eligible for these benefits at 100%? We'll be completing scheduled maintenance on Sunday (3/5) from 12 a.m. until 6 a.m. Blue Connect may be unavailable during this time. Find A Doctor Or Hospital In Your Network. Out of network billing can lead to unexpected charges. One its drawbacks is breast tissue can overlap during compression. Scenario 1: Brand Truvada, Viread, or Descovy may be made available if you are clinically unable to use generic Truvada. For more information, see the Blue Cross and Blue Shield Service Benefit Plan brochures. This screening is no cost to you. The Federal Patient Protection and Preventive Care Act (PPACA) was passed by Congress and signed into law by the President in March 2010. . According to the American Cancer Society, our state lags behind much of the nation in mammography screenings. Why did Blue Cross NC implement a diagnostic imaging management program? In contrast, 3D mammograms use CT (computed tomography) scans. . Tests that do not meet national clinical guidelines will not be approved. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. Individuals with a known history of Breast Cancer: Approve initial staging, with treatment [within three (3) months], and yearly surveillance for detection of recurrence or a new cancer. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. Women ages 35-39 can receive one baseline mammogram(four views). (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. Tissue doesnt overlap. A high BMI can be a warning sign for potential health problems. Regence supports women's preventive breast health. Annually about 220,000 women are diagnosed with breast cancer. Regular mammograms improve survival rates by, Thanks in part to preventive screenings, there are approximately, The average mammogram appointment is just. Your doctor may order a colonoscopy more frequently than every 10 years. Mammograms use very small doses of radiation and the risk of harm is very low. This happens by feeling breast tissue for any lumps or abnormal areas. Negotiated rates with providers can change, therefore, changing the estimate. The program does not currently apply to FEP, Medicare Supplemental or Medicare Prescription Drug Plans. Blue Cross Blue Shield of Massachusetts also offers insurance, pharmacy coverage, and Medicare Plans for seniors; life and disability insurance through Indigo Insurance Services (a wholly owned subsidiary); and insurance for individuals aged 18-26 years. Echocardiography studies (effective for both Commercial and Blue Medicare HMO\PPO lines of business as of January 2, 2014), Member identification number, name, date of birth, and health plan, Imaging exam(s) being requested (body part, right, left or bilateral), Patient diagnosis (suspected or confirmed), Clinical symptoms/indications (intensity/duration), Results of treatment history (previous tests, duration of previous therapy, relevant clinical medical history), American Institute of Ultrasound in Medicine (AIUM), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare & Medicaid Services (CMS) Local Coverage Determinations (LCD) and National Coverage Determinations (NCD), Promoting and guiding the selection of the most appropriate and cost-effective diagnostic imaging services, Encouraging standardization of medical practice patterns and reducing variation in clinical evaluation, Curtailing the performance of inappropriate diagnostic imaging studies, Advocating biosafety issues, including reduction of clinical radiation exposure (for CT and plain film radiography), Enhancing quality of health care for diagnostic imaging studies using evidence-based medicine and outcomes research from numerous resources. hb```,z@ (Mf`X b`Fe~F9}mS6.awa`\V_RQ g-e0 Mammograms: Women age 40 and older should have a screening mammogram every year and should continue to do so for as long as they are in good health. Blue Shield of California 1999 . Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. If your Summary of Benefits section of your Benefit Booklet contains PREVENTIVE CARE covered under federal law, then you have these benefits at no charge IN-NETWORK. When it's preventive: You get a mammogram to check for breast cancer. Focusing on the right test at the right time for the right patient could save time and mone and increase productivity. Side-to-side and top-to-bottom images are made. Of the 4 million women age 40 to 65 in Texas, 2.6 million . Mammograms use very small doses of radiation and the risk of harm is very low. Blue Medicare HMO and Blue Medicare PPO (as of September 1, 2010). Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). No family history, no risk. Access Your Payment Options. Others have a false sense of . http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. Site Map In fact, we rank 32nd out of 50 states. Breast cancer is the most widely found cancer in U.S. women, next to skin cancer. Mammograms are for older women. Issuance of a prior approval number is not a guarantee of payment. 2 The HPV vaccine (Gardasil) is covered to age 45 per the Food and Drug Administration (FDA) guidelines. 104 0 obj <> endobj Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. Screening mammograms every 12 months if you are a woman age 40 or older. Under the Affordable Care Act (ACA), CareFirst and other health insurance carriers must cover a set of preventive serviceslike shots and screening testsand no cost to you. One option is Adobe Reader which has a built-in screen reader. It often forms in the tubes that carry milk to the nipple (ducts) and in glands that make milk (lobules). Combined together, the X-rays create a three-dimensional picture of each breast. During your visit, your doctor will determine what tests or health screenings are right for you based on factors such as your age, gender, health status, and health and family history. Evaluation of suspected breast cancer when other imaging examinations, such as ultrasound and mammography, and physical examination are inconclusive for the presence of breast cancer, and biopsy could not be performed (e.g. Genetic counseling and evaluation can help determine if youve inherited a BRCA mutation. Most PDF readers are a free download. Be sure you're taking full advantage of your coverage. Diagnostic mammograms more frequently than once a year, if medically necessary. It happens in both men and women, but breast cancer in men is not common. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association . Most PDF readers are a free download. How should providers request prior approval? Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. Under the benefits of certain plans, the following diagnostic imaging services that are received in an outpatient setting, such as in a medical office, the outpatient department of a hospital or at a freestanding imaging center may require prior approval (for dates of service on or after February 15, 2007 for Blue Cross NC commercial plans and September 1, 2010 for Blue Medicare HMO and Blue Medicare PPO plans): Prior approval is not required when these procedures are performed in an emergency room, hospital (related to an inpatient or observation stay), urgent care center or ambulatory surgical center. This Bronze standard plan premium covers 60% of costs. Fargo (Headquarters) How do 3D Mammograms Differ From Standard Ones? What information is required to request prior approval? You should get screenings every one or two years, depending on your doctor's advice. Since their introduction, standard mammograms also called screening mammograms have helped save countless lives. Register Now, Ancillary and Specialty Benefits for Employees. Doses, recommended ages and recommended populations vary. Learn more aboutmammogram screeningsin this video. About 10% of patients who receive routine mammograms get called back for another look. Reimbursement Guidelines - Alphabetical Index, Reimbursement Guidelines - Categorical Index, Become a Blue Cross NC Provider or Recredential, Contact Information for Regional Network Management, Responsibilities of Primary Care Physicians (PCP) in 2008, IPP Coordination of Benefits Questionnaire. Talking with your healthcare provider about the . A follow-up study may be considered medically necessary to help evaluate an individual's progress after treatment, procedure, intervention or surgery. For more information, view our privacy policy. The cost of many screenings and checkups is covered at 100% with no out of pocket costs for you and those on your plan. Fraud and Abuse Yes. . Your doctor can help determine your risk level and what steps you should take. Regular mammograms improve survival rates by 35% in women over 50. Currently, under the Patient Protection and Affordable Care Act Annual Checkups and certain preventive . Select Your Gender. Forgot User ID? "To put it in perspective, the dose of radiation is lower than that of a chest x . Assessing Your Risk Scenario 2: Your claim for emtricitabine/tenofovir (generic Truvada) or Apretude is not paying at 100% and you are using it for PrEP. Best Answer. The diagnostic imaging management program guidelines are based on the most up-to-date recommendations of physician organizations such as the American College of Radiology and the American College of Cardiology. There are also additional guidelines if you're pregnant. All rights reserved. $100 outpatient benefits. hbbd``b` For more information, view our privacy policy. Still, over the past decade, there have been advances in mammogram technology. Depression screenings. Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. The USPSTF recommends biennial screening mammography for . Hysterectomies are not performed solely for sterilization so are not covered as preventive. Preventive care includes routine well exams, screenings and immunization intended to prevent or avoid illness or other health problems. Who Should Get It: Women age 21 - 65. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the . Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. . Coverage Information. Fraud and Abuse Technical Information Council and Blue Cross and Blue Shield of . The diagnostic imaging management program impact is low; why did Blue Cross NC implement it? Some women have a higher risk of developing cancer than other women. Standard 2D mammograms take two pictures of the breast. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. The average mammogram appointment is just 15 minutes long. But a damaged or broken gene can increase the risk of developing breast cancer. Servicing providers (hospitals, freestanding imaging centers, etc.) Blue Cross and Blue Shield Federal Employee Program Yesterday at 1:00 PM Simple yet warm, this customizable sheet pan lemon-roasted fish . The U.S. Preventive Services Task Force currently recognizes both 2D and 3D mammography as equally acceptable screening methods. Easy: Keeping up with your screenings is an important task, even in your busy life. Scroll down to see some common services that may or may not be covered during a preventive care visit. Breast cancer is the second leading cause of cancer deaths among women in the U.S. Under the benefits of certain plans, the following diagnostic imaging services that are received in an outpatient setting, such as in a medical office, the outpatient department of a hospital or at a freestanding imaging center may require prior approval (for dates of service on or after February 15, 2007 for Blue Cross NC commercial plans and September 1, 2010 for Blue Medicare HMO and Blue . Diagnostic care includes care or treatment when you have symptoms or risk factors and your doctor wants to diagnose them. Based on clinical criteria, AIM will issue a prior approval number or will forward requests to a nurse or physician if they require further review. The site may also contain non-Medicare related information. Most Florida Blue plans cover annual screening mammograms for women age 40 and older for as low as a $0 copay. The AIM physician reviewer may contact the ordering physician to discuss the case in greater detail within two (2) business days of receipt of the request. Log In to the Shopping Cart, Need to Make a Payment? Breast MRI should be bilateral except for those with a history of mastectomy or when the MRI is being performed expressly to further evaluate or follow findings in one (1) breast. They'll also look for early signs of breast and cervical cancer. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . https://www.anthem.com/health-insurance/health-care-reform-resources/reform-law-detail/more-womens-preventive-care-covered?reformlaw=l1019 Take advantage of preventive care and stop problems before they get serious. See your doctor andrefer to the CDCs posted schedule of immunizations for more information. Understand the difference between preventive and diagnostic. Ordering physicians for Blue Cross NC members must obtain prior approval prior to scheduling an imaging exam for outpatient diagnostic, non-emergent services. The issue of return on investment and appropriateness of guidelines will be continually addressed as part of the evaluation of the program. For women with a history of gestational diabetes who are not currently pregnant and who have not previously been diagnosed with type 2 diabetes. This is especially important for women who have dense breast tissue. No. The protection of your privacy will be governed by the privacy policy of that site. So why do so many women put off their mammograms? List of all medications that are covered at 100% onall formularies. Compare the prices of 26634 hotels in Ho Chi Minh City, Vietnam. Here's how to interpret your BMI: Below 18.5: underweight. However, if her doctor schedules a follow up mammogram six months later to re-examine that change, it would be used to diagnose a symptom, so it . 25 - 29.9: overweight. If you get benefits from your employer, you may also have these benefits. By using X-rays, they create two-dimensional images of the breast to spot suspicious tissue that may be cancerous. Who Should Get It: Sexually active women 24 years or younger and in women 25 years or older who are at increased risk of infection, Who Should Get It:Women at high risk of infection or pregnant women, Who Should Get It:Persons at high risk of acquiring HIV, Who Should Get It:Women to age 65 or older if at increased risk, Who Should Get It:Women at high risk of infection and pregnant women, Who Should Get It:Age 18 and older, including pregnant women, Who Should Get It:Women of reproductive age, Who Should Get It:Age 18 and older; when pregnant, Who Should Get It:Women, dependent children up to age 26, pregnant women, Who Should Get It:Women aged 40 to 60 years with normal or overweight body mass index (BMI) of 18.5 - 29.9. Some providers charge more, and some offer an uninsured discount. Find your ideal accommodation from hundreds of great deals and save with www.trivago.com Forgot User ID? Additional Screenings for High-Risk Women Routine mammograms are covered by the state health plan at no cost to you. For preoperative evaluation for known breast cancer when surgery planned within thirty (30) days; Evaluation of more than two (2) lesions to optimize surgical planning when requested by surgeon or primary care provider on behalf of surgeon who has seen the individual. Will this program impact members' ability to receive the tests they need? As a result, we believe that Blue Cross NC is taking an important step for patient safety and in managing increased costs by implementing a diagnostic imaging managing program. Call us at 1-888-243-4420 if you have questions or need help. $X^ "@\(k'h,@7HI?NH2012|Igl ` |> We have an obligation to our members to provide quality care at an affordable price. Examples of these services include: Initial evaluation. What process is in place for unfavorable determinations? Covered: Getting screened wont break the bank. Has Blue Cross NC considered disallowing self-referrals? TheU.S. Preventive Services Task Forcerecommends that women between the ages of 50 and 74 get a mammogram every two years. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. Most breast cancers are found in women 50 years old and older. Check your Benefit Booklet for details on other preventive care benefits. If physicians have questions about the Blue Cross NC diagnostic imaging management program, they should contact their local Network Management representatives. No lump, no cancer. "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. After your annual preventive exam, you will receive an Explanation of Benefits (EOB) from Blue Shield of California to notify you that your claim has been processed. Olvido su contrasea? 4510 13th Ave. S. To be covered with no out-of-pocket costs, the service must be: Special information for employees of religious organizations. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Fargo, N.D., 58121. seen only in single view mammogram without ultrasound correlation); Previous positive breast biopsy within the previous four (4) months and no intervening previous breast MRI; Evaluation of palpable lesion on physical examination and not visualized on ultrasound or mammogram and MRI guided biopsy considered; For evaluation of axillary node metastasis or adenocarcinoma with normal physical examination and normal breast mammogram; Individuals diagnosed with biopsy-proven lobular neoplasia or atypical ductal hyperplasia (ADH); Personal history of or first-degree relative with Le-Fraumeni syndrome (TP53 mutation), Cowden syndrome (PTEN) or Bannayan-RileyRuvalcaba syndrome (BRRS). Since being a carrier is relatively uncommon, doctors usually only test people with a family history of breast or ovarian cancer. Learn the facts, and then schedule an appointment today! Standard 2D mammograms take two pictures of the breast. Linked Apps. All rights reserved. The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue Shield of Alabama. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . Many travel vaccines are not covered including: Your doctor will determine what tests or health screenings are needed based on your age, gender, and overall health status. MRI findings should be correlated with clinical history, physical examination results, and the results of mammography and any other prior breast imaging. Learn more about our other insurance plans and Medicare plans, or contact a sales . Description: Screening for cervical cancer. One of the goals of this program is to help contain health care costs. Please send us your question so a licensed agent can contact you. Through a preventive exam and routine health screenings, your doctor can determine your current health status and detect early warning signs of more serious, costly problems. Check out the changes and updates to our plan in 2023. Note: The Illinois Insurance Code requires all health insurers to provide coverage for mammography, including: one baseline study age 35-39, and an annual mammogram for women 40 and older. Usage Agreement We apologize for any inconvenience. No prescription medication or NRT limit when received via pharmacy benefit, Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap). Cat-scan technology exposes patients to more radiation than an X-rays. Achieving this requires that we reduce the number of imaging examinations that do not add diagnostic value for members. Reimbursement Policy: Screening and Diagnostic Mammography & 3D Tomosynthesis Effective Date: April 15, 2017 Last Reviewed Date: February 14, 2023 Purpose: Provide guidelines for the processing of claims for multiple mammograms, CAD and Digital Breast Tomosynthesis (DBT) to align with recent changes to CMS' position on screening and diagnostic mammograms and to define what a mammographic . Fewer false alarms reduce unnecessary re-testing along with stress and worry. Will the diagnostic imaging management program increase the risk of malpractice? Preventive Care. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. You should call the number on the back of your member ID card for more information before you schedule one. Additionally, we cover computer-assisted detection for those women who seek an extra level of screening for breast cancer. Limited to a 90 day supply each for two cessation efforts. You can also visit our Mental Health Resource . For that reason, benefits for preventive BRCA testing are available for members with a family history of certain cancers. By Regence. Do practicing North Carolina physicians have input into the program? Originally published 11/16/2015; Revised 2019, 2022, Get News & Updates Directly To Your Inbox. However, your group may decide to delay the effective date for coverage until your group's plan . Lumps can be very difficult to feel on your own, which is why its recommended that women over the age of 40 receive regular mammograms. MRI of the breast may be considered medically necessary for individuals with silicone implants whenEITHERof the following are met: MRI of the breast may be considered medically necessary for individuals with no history of known breast cancer, MRI of the breast may be considered medically necessary for individuals with history of known breast cancer. Blue Shield of California is an independent member of the Blue Shield Association. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Psychotherapy. %%EOF You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. Blue Cross NC data confirm there is significant opportunity to contain health care costs and reduce member exposure to radiation by eliminating scans that are clinically inappropriate or noncontributory to the care. As a result, 3D mammograms lower the number of false alarms. Blue Cross NC is very aware of the concerns about self-referral. . In addition, some sites may require you to agree to their terms of use and privacy policy. NRT through QuitlineNC is available without a prescription. Generally, practicing consistently with national evidence-based guidelines is expected to reduce errors and liability. You must also receive prior approval from us. Blue Cross Blue Shield Global Core gives Blue Cross and Blue Shield of Vermont members access to their health care benefits wherever they go - across the country and around the world.
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