blue cross blue shield mammogram coverage blue cross blue shield mammogram coverage

Breast cancer is the most common type of cancer in women. Inscribirse ahora! Here's how to interpret your BMI: Below 18.5: underweight. Why did Blue Cross NC implement a diagnostic imaging management program? Breast cancer risk factors include: Check with your doctor if you have questions about mammograms or other breast cancer screenings. Some buy into dangerous myths about breast cancer. "To put it in perspective, the dose of radiation is lower than that of a chest x-ray," Mehta said. This new site may be offered by a vendor or an independent third party. Most PDF readers are a free download. When it's diagnostic: If your doctor . Am I eligible for these benefits at 100%? File is in portable document format (PDF). All rights reserved. Preventive Care Plans & Guidelines. Your dashboard may experience future loading problems if not resolved. How do 3D Mammograms Differ From Standard Ones? Side-to-side and top-to-bottom images are made. Regular mammograms improve survival rates by 35% in women over 50. All rights reserved. Blue Cross NC will be the fourth company to implement a diagnostic imaging program in North Carolina. Coverage Information. This Bronze standard plan premium covers 60% of costs. We will work with the physician community through our Diagnostic Imaging Management Advisory Group to assure that there is no negative impact on the quality of patient care as a result of this initiative. No lump, no cancer. Privacy Policy Cat-scan technology exposes patients to more radiation than an X-rays. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. They can help detect breast cancer up to three years before it can be felt. Health Insurance Tax Information; Transparency in Coverage; Mental Health Parity; Teledentistry Services Covered; . This happens by feeling breast tissue for any lumps or abnormal areas. We use cookies on this website to give you the best experience and measure website usage. As we see trends evolve that may impact patient safety, quality of care or affordability, we must implement solutions that protect our members from these trends. Be sure you're taking full advantage of your coverage. Health coverage is offered by Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. Screening can help find breast cancer early, when it is easier to treat. Most breast cancers are found in women 50 years old and older. 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. For women with a history of gestational diabetes who are not currently pregnant and who have not previously been diagnosed with type 2 diabetes. Still, the overall benefit of 2D and 3D breast cancer screening outweigh any potential risks linked to radiation exposure. 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. Check out the changes and updates to our plan in 2023. If you have an HMO or POS plan, there are some additional services you'll need approval for. Blue Shield of California is an independent member of the Blue Shield Association. While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram. 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. How do 3D Mammograms Differ From Standard Ones? Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. The program does not currently apply to FEP, Medicare Supplemental or Medicare Prescription Drug Plans. According to the American Cancer Society, our state lags behind much of the nation in mammography screenings. Salpingectomy for sterilization purposes will be covered as preventive effective 7.1.22, Trans-dermal contraceptives (i.e., contraceptive patches), Diaphragms are available only through the pharmacy and IUDs are available only through a professional provider, If there is a medical reason you cannot take a generic contraceptive, your doctor should review this, Diaphragms, vaginal rings, contraceptive patches, female condoms, sponges, spermicides, and emergency contraception are available only with a prescription. Disponible nicamente en ingls. By using X-rays, they create two-dimensional images of the breast to spot suspicious tissue that may be cancerous. The following contraceptive methods (devices and associated procedures, such as device removal, and pharmaceutical contraceptives) for women with reproductive capacity: Emergency contraception (i.e., morning after pill, Plan B, ella), Effective 8.1.22, one annual subscription to, a prescription from an in-network provider that includes the name of the app, Natural Cycles fertility app, Injections (only covered as preventive for Medoxyprogesterone Acetate 150 mg, which is the only drug and dosage used for contraception), Oral contraceptives (all generic contraceptives will be covered as preventive; brand oral contraceptives will continue to require member cost sharing (e.g., deductible, copay, and/or coinsurance) View a complete, OTC contraceptives (female condoms, all products; sponges, all products; spermicides, all products, male condoms effective 1.1.23), Sterilization procedures including tubal ligation (tying of fallopian tubes) and salpingectomy (removal of fallopian tubes). BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. 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. Of the 4 million women age 40 to 65 in Texas, 2.6 million . Coverage that is supplemental to Medicare but with no member cost There is an appeals process in place for unfavorable determinations. A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. Mammograms arent as painful as you think you may feel a little pressure but it only lasts a few seconds. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. It is important to note that these services are free only when delivered by a doctor or other . Talking with your healthcare provider about the . Generally, practicing consistently with national evidence-based guidelines is expected to reduce errors and liability. 2023 Blue Cross Blue Shield of North Dakota, Please wait while your form is being submitted, Directory Validation Instructions (No Surprises Act), Recredentialing & Credentialing Applications. Blue Shield of California 1999 . Find your ideal accommodation from hundreds of great deals and save with www.trivago.com This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. How does Blue Cross NC ensure that the program does not negatively impact patient care, divert physicians from the practice of medicine or compromise the patient/physician relationship? Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Who reviews requests for diagnostic imaging prior approval? Mental Health Services. Access Your Payment Options. HMO coverage is offered by Health Options, Inc. DBA Florida Blue HMO. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . If there is a medical reason you cannot use a generic statin, your doctor should review this. If you get benefits from your employer, you may also have these benefits. Combined together, the X-rays create a three-dimensional picture of each breast. One option is Adobe Reader which has a built-in reader. The average mammogram appointment is just 15 minutes long. Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. Tests that do not meet national clinical guidelines will not be approved. The AIM medical guidelines are publicly available and reviewed regularly by radiologists and practicing physicians of many specialties and updated based on the most current medical evidence. You will be required to pay the plan's physician office copayment or coinsurance. Standard 2D mammograms take two pictures of the breast. In addition, some sites may require you to agree to their terms of use and privacy policy. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. Regence supports women's preventive breast health. Even if you're feeling fine, scheduling an appointment with your doctor for preventive care services is important. Approve annually starting at age 30; Individuals not yet tested for BRCA gene, but with known BRCA mutation in first degree relative. BSC6.07 Digital Breast Tomosynthesis. 2023 Blue Cross and Blue Shield of North Carolina. When were Blue Cross NC's diagnostic imaging prior approval policies effective? Tissue doesnt overlap. How should providers request prior approval? Technical Information All women need to be informed by their healthcare provider about the best screening options for them. Heres a deeper dive on the potential benefits and risks of a 3D mammogram. 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. A follow-up study may be considered medically necessary to help evaluate an individual's progress after treatment, procedure, intervention or surgery. 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. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. Focusing on the right test at the right time for the right patient could save time and mone and increase productivity. If physicians have questions about the Blue Cross NC diagnostic imaging management program, they should contact their local Network Management representatives. Additional mammograms may require cost sharing. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. TheU.S. Preventive Services Task Forcerecommends that women between the ages of 50 and 74 get a mammogram every two years. Mammograms use very small doses of radiation and the risk of harm is very low. If you discuss new medical concerns or a current illness, the entire visit may be considered a medical treatment visit and would not be covered as preventive care. 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. But Humana, which I have now, is even worse because I have a $50 copay just for screening." 3. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the . Learn the facts, and then schedule an appointment today! Disponible nicamente en ingls. 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. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. The cost estimate changed prior to your care. Breast cancer mammography (at least one baseline mammogram during the 5-year period a member is age 35 through 39 and one mammogram for each member in each calendar year for a member age 40 or older) . BATON ROUGE - October is Breast Cancer Awareness Month. If you provide a phone number, an agent may call you to make sure that you received the information and to answer any questions that you might have. Screening mammograms every 12 months if you are a woman age 40 or older. 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 . No lump, no cancer. During this visit, your doctor examines your overall health. Find an in-network doctor for preventive care. Mammograms use very small doses of radiation and the risk of harm is very low. to expand insurance coverage for diagnostic mammograms. As a result, 3D mammograms lower the number of false alarms. A high BMI can be a warning sign for potential health problems. recipe is no mess, no fuss and all flavor. Please send us your question so a licensed agent can contact you. Blue Cross and Blue Shield of Louisiana joins other healthcare organizations in reminding Louisianians how important it is to know your personal health risks and ask your doctor about screening. Please enter a valid date of birth (MM/DD/YYYY), 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, PDF File is in portable document format (PDF). hb```,z@ (Mf`X b`Fe~F9}mS6.awa`\V_RQ g-e0 HMO Scope of Benefits Section . The USPSTF recommends biennial screening mammography for . Theyll also look for early signs of breast and cervical cancer. Here's a deeper dive on the potential benefits and risks of a 3D mammogram. 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. We have an obligation to our members to provide quality care at an affordable price. CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval. Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. Diagnostic mammograms more frequently than once a year, if medically necessary. For screening examination to detect breast cancer in. Routine health checkups. Regular mammograms improve survival rates by, Thanks in part to preventive screenings, there are approximately, The average mammogram appointment is just. We apologize for any inconvenience. Breast Cancer and Early Detection: What Women Need to Know. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. "Breast cancer is the most common cancer in American women, but men can also develop breast cancer," said Blue Cross and Blue Shield of . When it's preventive: You get a mammogram to check for breast cancer. Providers can find complete instructions on how to request prior approval outlined on the diagnostic imaging procedures page. 2020. . Inscribirse ahora! (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. All premiums listed represent coverage for dependents up to age 26. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Currently, about 12% of women will develop breast cancer at some point in their lifetime. Call us at 1-888-243-4420 if you have questions or need help. Diagnostic care includes care or treatment when you have symptoms or risk factors and your doctor wants to diagnose them. The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue Shield of Alabama. Women ages 40 and older can receive a mammogram (four views) each calendar year. Screening for depression in postpartum women. To be covered with no out-of-pocket costs, the service must be: Special information for employees of religious organizations. Assessing Your Risk Blue Cross and Blue Shield Association . Your coverage may vary from the types of benefits listed below. Separately billed services are not covered under preventive services and are subject to the normal benefits based on place of service, may have them as a covered benefit, but not as a preventive care benefit covered at 100%, may not have contraceptive benefits through your group medical plan, If either of these two scenarios apply to you, have your provider fill out and fax. 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. This new site may be offered by a vendor or an independent third party. This is very important in clinical decision making as alternative therapies may be selected based upon the results obtained from the MRI. Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. 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. The program is expected to assist Blue Cross NC in improving affordability for our members. No. Screenings, tests and other preventive care services Preventive care service Cost . http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. This screening is no cost to you. Site Map Dental, Life and Disability are offered by Florida Combined Life . Blue Cross and Blue Shield of Illinois . Genetic counseling and evaluation can help determine if youve inherited a BRCA mutation. This can get confusing, so call your health plan before you go. Thanks in part to preventive screenings, there are approximately 2.8 million breast cancer survivors in the U.S. as of 2016. Does this prior approval impact Blue Medicare HMO and Blue Medicare PPO? Your doctor will collect a sample of cells from your cervix to test for any abnormal or precancerous cells. 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. 104 0 obj <> endobj However, about 72% of women with BRCA1 and about 69% of women with BRCA2 will develop breast cancer by the age of 80. The site may also contain non-Medicare related information. Fargo, N.D., 58121. Scenario 2: Your claim for emtricitabine/tenofovir (generic Truvada) or Apretude is not paying at 100% and you are using it for PrEP. 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. Your doctor will advise on recommended immunizations that can protect against a number of serious diseases. Your member ID card is your key to using your medical plan benefits. Your coverage information in the palm of your hand. Understand the difference between preventive and diagnostic. What clinical criteria does AIM use to determine if a procedure will be approved? Since being a carrier is relatively uncommon, doctors usually only test people with a family history of breast or ovarian cancer. Internal Medical Policy Committee 11-19-2020 Annual Review-Title changed slightly, Internal Medical Policy Committee 11-23-2021 Annual Review-no changes in criteria, Internal Medical Policy Committee 11-29-2022 Annual Review-no changes in criteria. Forgot User ID? 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 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. If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this. Breast tomosynthesis is an . Some buy into dangerous myths about breast cancer. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Summary of Arkansas Blue Cross Blue Shield and Health Advantage Coverage Polices. Life-Saving: Cancer detection is the key to early treatment and better outcomes. %%EOF No prescription medication or NRT limit when received via pharmacy benefit, Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap). Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services. Some sites may require you to agree to their terms of use and privacy policy. Find out what preventive care services are appropriate for you and build a list to share with your doctor. Learn more aboutmammogram screeningsin this video. 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. Fraud and Abuse "To put it in perspective, the dose of radiation is lower than that of a chest x . Women between the ages of 40 and 49 should talk to their doctor about when they should start getting mammograms. Some women have a higher risk of developing cancer than other women. It often forms in the tubes that carry milk to the nipple (ducts) and in glands that make milk (lobules). Your member ID card is your key to using your medical plan benefits. Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. Limited to a 90 day supply each for two cessation efforts. 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. endstream endobj 105 0 obj <. Starting June 1, 2022, this follow up colonoscopy will be covered at 100%.