blue cross blue shield mammogram coverage

Necesita su ID de usuario? 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. 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. If you have questions about coverage for preventive services, . Copyright 2023 Health Care Service Corporation. If so, it should not impact the ability of members to receive these tests. No family history, no risk. Learn more aboutmammogram screeningsin this video. Please review the terms of use and privacy policies of the new site you will be visiting. Health plans are offered by Blue Shield of California. Combined together, the X-rays create a three-dimensional picture of each breast. Disponible nicamente en ingls. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. Use this tool to create personalized recommendations for your . , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Routine mammograms are covered by the state health plan at no cost to you. Here's a deeper dive on the potential benefits and risks of a 3D mammogram. Currently, under the Patient Protection and Affordable Care Act Annual Checkups and certain preventive . 2023 Blue Cross and Blue Shield of North Carolina. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. MRI findings should be correlated with clinical history, physical examination results, and the results of mammography and any other prior breast imaging. Women ages 35-39 can receive one baseline mammogram(four views). Do practicing North Carolina physicians have input into the program? Mental Health Services. Additional mammograms may require cost sharing. Your coverage may vary from the types of benefits listed below. . hb```,z@ (Mf`X b`Fe~F9}mS6.awa`\V_RQ g-e0 Coverage is subject to the specific terms of the member's benefit plan. No family history, no risk. However, about 72% of women with BRCA1 and about 69% of women with BRCA2 will develop breast cancer by the age of 80. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Heres everything you need to know about it. Women ages 40 and older can receive a mammogram (four views) each calendar year. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. Blue Cross and Blue Plus plans cover these eligible preventive services for women ages 12-64, with no member cost sharing when obtained at the in-network level*: Alcohol and substance misuse counseling. What are the goals of the diagnostic imaging management program? Help Center. The average mammogram appointment is just 15 minutes long. The diagnostic imaging management program impact is low; why did Blue Cross NC implement it? By using X-rays, they create two-dimensional images of the breast to spot suspicious tissue that may be cancerous. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the . Breast cancer risk factors include: Check with your doctor if you have questions about mammograms or other breast cancer screenings. Ordering physicians may also contact the AIM physician reviewer at any time during the authorization process. Which health plans does the program apply to? "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. The good news is that mammograms can catch cancer early, when its easiest to treat, even if you dont have any symptoms. Your doctor will advise on recommended immunizations that can protect against a number of serious diseases. According to the American Cancer Society, our state lags behind much of the nation in mammography screenings. However, sometimes tests are ordered and are not clinically appropriate. Health coverage is offered by Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. Reproduction without authorization from Blue Shield of California is prohibited. Pays cash if you're treated for cancer. For this reason, 2D mammograms can sometimes produce inaccurate findings. 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. Plus, your medical plan covers 100% of the costs for preventive health services when care is provided through network providers. For transgendered individuals, you have access to medically appropriate preventive services. This is very important in clinical decision making as alternative therapies may be selected based upon the results obtained from the MRI. Will this program impact members' ability to receive the tests they need? Blue Cross NC created a Diagnostic Imaging Advisory Group, which includes North Carolina physicians who order and render radiology services and representatives of major medical organizations, to allow for medical community feedback. Access Your Payment Options. Mammograms are for older women. Additionally, the increased use of some high technology imaging procedures creates patient safety concerns from radiation exposure. listed below will be covered by your plan. Your coverage information in the palm of your hand. Blue Cross and Blue Shield Service Benefit Plan brochures, https://www.mayoclinic.org/tests-procedures/brca-gene-test/about/pac-20384815. Privacy Policy Yes, they will cover annual mammograms if they are suitable to age. Blue Cross NC is the fourth insurer in the state to implement a diagnostic imaging management program, and we understand that our physician community has vital feedback that will help make our program successful. Regence supports women's preventive breast health. Your dashboard may experience future loading problems if not resolved. Your doctor will collect a sample of cells from your cervix to test for any abnormal or precancerous cells. HMO coverage is offered by Health Options, Inc. DBA Florida Blue HMO. For women age 30-65. Are you going to reimburse providers for the savings Blue Cross NC will incur? Best Answer. Call us at 1-888-243-4420 if you have questions or need help. Assessing Your Risk This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs. To view this file, you may need to install a PDF reader program. Of the 4 million women age 40 to 65 in Texas, 2.6 million . What information is required to request prior approval? Take advantage of preventive care and stop problems before they get serious. Learn more about our non-discrimination policy and no-cost services available to you. hrHPV test only every 5 years. Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : mammograms. . All premiums listed represent coverage for dependents up to age 26. Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested. You have coverage from another insurance plan in addition to your Blue Cross and Blue Shield of Nebraska coverage. Barium enema is a covered service but not at 100% so you may have out of pocket costs. Breast cancer is the second leading cause of cancer deaths among women in the U.S. 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 They'll also look for early signs of breast and cervical cancer. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. Achieving this requires that we reduce the number of imaging examinations that do not add diagnostic value for members. FDA-approved tobacco cessation prescription. Standard 2D mammograms take two pictures of the breast. Blue Shield of California is an independent member of the Blue Shield Association. If eligible, you must receive genetic counseling and evaluation services before you receive preventive BRCA testing. So why do so many women put off their mammograms? Health Insurance Tax Information; Transparency in Coverage; Mental Health Parity; Teledentistry Services Covered; . The program is expected to assist Blue Cross NC in improving affordability for our members. The scans take detailed X-ray images from many angles. endstream endobj startxref Accessibility Here's a deeper dive on the potential benefits and risks of a 3D mammogram. Necesita su ID de usuario? 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. Screening can help find breast cancer early, when it is easier to treat. You will be required to pay the plan's physician office copayment or coinsurance. Learn more about our non-discrimination policy and no-cost services available to you. You must be at least 18 years old to submit a request. 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. Copy. 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. It's important for adult women to have annual wellness exams after the age of 21. If you get benefits from your employer, you may also have these benefits. Breast Cancer. 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. 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. List of all medications that are covered at 100% onall formularies. Most PDF readers are a free download. Blue Cross and Blue Shield Association. Covered: Getting screened wont break the bank. About one in every seven or eight women gets it in her lifetime. Examples of these services include: Initial evaluation. Forgot User ID? Linked Apps. 25 - 29.9: overweight. The program will apply to members covered by the following plans: Blue Options SM (group PPO plan), Blue Option HRA (group PPO plan), Blue Options HSA (group and individual PPO plan), Classic Blue (Group CMM plan), Dental Blue (group and individual dental plan), Blue Advantage (individual PPO), Short Term Health Care (individual CMM plan). Cat-scan technology exposes patients to more radiation than an X-rays. By continuing to use this website, you consent to these cookies. If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this. You can also visit our Mental Health Resource . No. Limited to a 90 day supply each for two cessation efforts. Mammograms use very small doses of radiation and the risk of harm is very low. Regular mammograms improve survival rates by, Thanks in part to preventive screenings, there are approximately, The average mammogram appointment is just. 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) . Others have a false sense of . - 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. Most basis mammogram screenings are covered by your health plan. Find out what preventive care services are appropriate for you and build a list to share with your doctor. This Bronze standard plan premium covers 60% of costs. No coverage for oral contraceptive devices. What imaging procedures do NOT require prior approval? Blue Cross and Blue Shield of Illinois . Blue Cross and Blue Plus health plans cover both 2D and 3D preventive screening mammograms at no cost to members when you use an in-network provider. Scenario 1: Brand Truvada, Viread, or Descovy may be made available if you are clinically unable to use generic Truvada. Standard 2D mammograms take two pictures of the breast. Blue Medicare HMO and Blue Medicare PPO (as of September 1, 2010). 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. 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? Understand the difference between preventive and diagnostic. CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval. Coverage is subject to the specific terms of the member's benefit plan. 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). BRCA is an abbreviation for the BReast CAncer gene, which is an inherited trait. Hysterectomies are not performed solely for sterilization so are not covered as preventive. 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. Am I eligible for these benefits at 100%? The site may also contain non-Medicare related information. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Screenings, tests and other preventive care services Preventive care service Cost . 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. 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. Does this prior approval impact Blue Medicare HMO and Blue Medicare PPO? Easy: Keeping up with your screenings is an important task, even in your busy life. Annually about 220,000 women are diagnosed with breast cancer. Coverage that is supplemental to Medicare but with no member cost BATON ROUGE - October is Breast Cancer Awareness Month. Has Blue Cross NC considered disallowing self-referrals? Blue Cross and Blue Shield Association . It is important to note that these services are free only when delivered by a doctor or other . While 3D mammograms show some promise in better health outcomes, there isnt enough research to advocate them over 2D mammograms. Disponible nicamente en ingls. NRT through QuitlineNC is available without a prescription. For screening examination to detect breast cancer in. 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. Accessibility You should get screenings every one or two years, depending on your doctor's advice. Clinical breast exam: Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a regular exam by a health professional, at least every three years. Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room. Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. 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. The goal of the Blue Cross NC Diagnostic Imaging Program is to improve affordability for Blue Cross NC members. 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. Still, the overall benefit of 2D and 3D breast cancer screening outweigh any potential risks linked to radiation exposure. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . 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. Our goal is to review diagnostic imaging tests to determine if each test is clinically appropriate for the specific situation. Provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions. It often forms in the tubes that carry milk to the nipple (ducts) and in glands that make milk (lobules). NRT through the pharmacy benefit is available only with a prescription. Provided by an in-network doctor or facility (urgent care facility, outpatient clinic or ambulatory surgery center), Filed by your doctor as a preventive care visit, Identified as preventive care under the Affordable Care Act (ACA), In women age 2129 with cervial cytology (pap test) every 3 years, A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. Even if you're feeling fine, scheduling an appointment with your doctor for preventive care services is important. Usage Agreement Mammograms are for older women. There are also additional guidelines if you're pregnant. Depression screenings. 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. Colorectal Cancer . Some preventive care services require that you meet .

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