blue cross blue shield mammogram coverage

Understand the difference between preventive and diagnostic. MRI findings should be correlated with clinical history, physical examination results, and the results of mammography and any other prior breast imaging. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. According to the American Cancer Society, our state lags behind much of the nation in mammography screenings. No family history, no risk. Telligent is an operating division of Verint Americas, Inc., an independent company that provides and hosts an online community platform for blogging and access to social media for Blue Cross and Blue Shield of Illinois. Screening for high cholesterol is also covered at 100% every 5 years or annually for those with increased risk for CVD. Routine gynecological visits. Approve annually starting at age 30; Individuals not yet tested for BRCA gene, but with known BRCA mutation in first degree relative. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . Combined together, the X-rays create a three-dimensional picture of each breast. . Routine mammograms are covered by the state health plan at no cost to you. No prescription medication or NRT limit when received via pharmacy benefit, Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap). 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. Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years. Who Should Get It: Women age 21 - 65. A high BMI can be a warning sign for potential health problems. Some Blue Cross NCmembers who are employees of religious organizations and their dependents: Talk to your employer or check your benefit booklet to confirm your coverage for these benefits and any limitations. Counseling. Please review the terms of use and privacy policies of the new site you will be visiting. Scenario 1: Brand Truvada, Viread, or Descovy may be made available if you are clinically unable to use generic Truvada. In contrast, 3D mammograms use CT (computed tomography) scans. Plus, your medical plan covers 100% of the costs for preventive health services when care is provided through network providers. Mammograms are for older women. 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 . 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. 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 . Find out what preventive care services are appropriate for you and build a list to share with your doctor. Talk to your doctor to find out which of these you should have based on your health. Nothing to fear: Its normal to feel scared before any medical procedure, but theres nothing to worry about! 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. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. 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. If you have a higher risk for breast cancer, talk to your doctor about screening, no matter how old you are. 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. However, about 72% of women with BRCA1 and about 69% of women with BRCA2 will develop breast cancer by the age of 80. If you had a polyps removed during a previous preventive screening colonoscopy, future colonoscopies will be covered but may not be considered preventive so you may have out of pocket costs. Linked Apps. Healthy tissue may appear suspicious and cancerous tissue can be masked. NRT through the pharmacy benefit is available only with a prescription. The program is expected to assist Blue Cross NC in improving affordability for our members. Inscribirse ahora! Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Screenings, tests and other preventive care services Preventive care service Cost . 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. Olvido su contrasea? BATON ROUGE - October is Breast Cancer Awareness Month. Should a member request Some preventive care services require that you meet . There are significant concerns about patient safety involved in the increased exposure to radiation due to diagnostic imaging procedures. - Ebonie from Chicago, IL [Humana HMO] "I used to have Blue Cross Blue Shield and we didn't have a copay for normal mammograms but even then, I still paid $1700 because the no-cost mammogram lead to ultrasound, another mammogram, and an MRI. SOURCES: Your doctor may order a colonoscopy more frequently than every 10 years. Others have a false sense of . For evaluation of identified lesion, mass or abnormality in breast in. They'll also look for early signs of breast and cervical cancer. Heres everything you need to know about it. *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 . It's important to note that your provider has the right to code and bill services according to his or her viewpoint. Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross Blue Shield Association, serving residents and business in North Dakota. Regular mammograms improve survival rates by, Thanks in part to preventive screenings, there are approximately, The average mammogram appointment is just. A Pap test every 3 years or. Forgot Password? Anemia screening for pregnant women. Privacy Policy There is an appeals process in place for unfavorable determinations. This happens by feeling breast tissue for any lumps or abnormal areas. Copyright 2023 Health Care Service Corporation. Olvido su contrasea? Access Your Payment Options. Blue Shield of California 1999 . Will the diagnostic imaging management program increase the risk of malpractice? 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. http://www.breastcancer.org/symptoms/understand_bc/statistics Currently, under the Patient Protection and Affordable Care Act Annual Checkups and certain preventive . Register Now, Ancillary and Specialty Benefits for Employees. However, some services like 3D imaging or ultrasounds may not be fully covered the same way. You should call the number on the back of your member ID card for more information before you schedule one. Starting June 1, 2022, this follow up colonoscopy will be covered at 100%. You have coverage from another insurance plan in addition to your Blue Cross and Blue Shield of Nebraska coverage. You will be required to pay the plan's physician office copayment or coinsurance. What places or settings of treatment are affected? CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval. 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. Description: clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy. Coverage is subject to the specific terms of the member's benefit plan. Screening mammograms every 12 months if you are a woman age 40 or older. These benefits are available for members of non-grandfathered individual health insurance plans. 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. 4510 13th Ave. S. Accessibility These benefits are currently in effect unless otherwise noted. Did you know that one in eight women will develop invasive breast cancer at some point in her life? What imaging procedures do NOT require prior approval? There has been an error with your submission. You should get screenings every one or two years, depending on your doctor's advice. 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? hb```,z@ (Mf`X b`Fe~F9}mS6.awa`\V_RQ g-e0 If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this. During this visit, your doctor examines your overall health. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Its common to receive a Pap test (also called a Pap smear or pelvic exam) during your visit. Side-to-side and top-to-bottom images . Please review the terms of use and privacy policies of the new site you will be visiting. Inscribirse ahora! Heres a deeper dive on the potential benefits and risks of a 3D mammogram. Women who get a 3D mammogram may also get a traditional 2D mammogram, exposing them to higher amounts of radiation. This Bronze standard plan premium covers 60% of costs. Women ages 40 and older can receive a mammogram (four views) each calendar year. American Imaging Management (AIM) was selected as a vendor in part due to their track record of creating cost savings while reducing the unnecessary administrative burden on physician offices. When were Blue Cross NC's diagnostic imaging prior approval policies effective? Blue Cross NC will be the fourth company to implement a diagnostic imaging program in North Carolina. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. It often forms in the tubes that carry milk to the nipple (ducts) and in glands that make milk (lobules). 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. Approve annually starting at age 30. Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. Health coverage is offered by Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. They are regularly reviewed by physicians of appropriate specialties for consistency with the most recent medical evidence. By using X-rays, they create two-dimensional images of the breast to spot suspicious tissue that may be cancerous. If eligible, you must receive genetic counseling and evaluation services before you receive preventive BRCA testing. The issue of return on investment and appropriateness of guidelines will be continually addressed as part of the evaluation of the program. Log In to the Shopping Cart, Need to Make a Payment? Its important for adult women to have annual wellness exams after the age of 21. Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). 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%. 122 0 obj <>/Filter/FlateDecode/ID[<13345823F9F84C49978F51E9E4B0DEB3><85AA0C7815CFFF46BE97C496C3A4895B>]/Index[104 37]/Info 103 0 R/Length 89/Prev 75360/Root 105 0 R/Size 141/Type/XRef/W[1 2 1]>>stream As an example, women get regular mammograms at no cost to them as a preventive screening. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Typical costs: For an uninsured patient, typical full-price cost of a mammogram ranges from $80 to $120 or more, with an average of about $102, according to Blue Cross Blue Shield of North Carolina. Why did Blue Cross NC implement a diagnostic imaging management program? Additionally, we cover computer-assisted detection for those women who seek an extra level of screening for breast cancer. However, your group may decide to delay the effective date for coverage until your group's plan . The American Cancer Society recommends women ages 40 to 54 get annual mammograms, and women 55 and older get screenings every two years. To view this file, you may need to install a PDF reader program. For evaluation of breast lesion, identifying whether single or multi-focal, in individual with diagnosed breast cancer; For evaluation of suspicious mass, lesion, distortion or abnormality of breast in individual with history of breast cancer. As North Dakotans, we can do better in checking for breast cancer. NRT through QuitlineNC is available without a prescription. During this visit, your doctor examines your overall health. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. The site may also contain non-Medicare related information. Understanding Health Care Costs and Quality, Provider Finder -Network Selection Criteria, HMO Provider Network Important Information, Making Your Health Insurance Work For You, Prescription Drug Changes and Pharmacy Information, Machine Readable Files for Transparency in Coverage. Summary of Arkansas Blue Cross Blue Shield and Health Advantage Coverage Polices. A follow-up study may be considered medically necessary to help evaluate an individual's progress after treatment, procedure, intervention or surgery. TheU.S. Preventive Services Task Forcerecommends that women between the ages of 50 and 74 get a mammogram every two years. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. The Diagnostic Imaging Management Advisory Group is asked to help develop future phases of the diagnostic imaging program, including addressing over-utilization by self-referring physicians as necessary. 3D mammograms may be covered by your health plan. Necesita su ID de usuario? The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue Shield of Alabama. By Regence. 0 BRCA is an abbreviation for the BReast CAncer gene, which is an inherited trait. The policies were effective September 1, 2010 for Blue Medicare HMO and Blue Medicare PPO plans. This is very important in clinical decision making as alternative therapies may be selected based upon the results obtained from the MRI. Our goal is to review diagnostic imaging tests to determine if each test is clinically appropriate for the specific situation. Colorectal Cancer . Screening for Cervical Cancer 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 Florida Blue Medicare health plan includes a mammogram screening every year for women age 40 and over. 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. AIM has a track record of successful experience working with many providers and other Blue Cross and Blue Shield plans across the country. The protection of your privacy will be governed by the privacy policy of that site. Fraud and Abuse Am I eligible for these benefits at 100%? Talking with your healthcare provider about the . Serving Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. For transgendered individuals, you have access to medically appropriate preventive services. About 10% of patients who receive routine mammograms get called back for another look. Most breast cancers are found in women 50 years old and older. Register Now, Ancillary and Specialty Benefits for Employees. A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. Preventive Care Guidelines. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. List of all medications that are covered at 100% onall formularies.