blue cross blue shield mammogram coverage
This Bronze standard plan premium covers 60% of costs. How long is an authorization of a diagnostic imaging procedure valid? http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. Most PDF readers are a free download. Your doctor can help determine your risk level and what steps you should take. You usually need to get tested every 3 to 5 years. There are many easy-to-use BMI calculators online, such as this example from the Centers for Disease Control and Prevention.*. %%EOF https://www.anthem.com/health-insurance/health-care-reform-resources/reform-law-detail/more-womens-preventive-care-covered?reformlaw=l1019 *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? To be covered with no out-of-pocket costs, the service must be: Special information for employees of religious organizations. The program is expected to assist Blue Cross NC in improving affordability for our members. Screening can help find breast cancer early, when it is easier to treat. 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 . "To put it in perspective, the dose of radiation is lower than that of a chest x . 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. Technical Information Your dashboard may experience future loading problems if not resolved. hrHPV test only every 5 years. Provider consultation prior to the colonoscopy procedure is covered at 100%. We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. For transgendered individuals, you have access to medically appropriate preventive services. Since their introduction, standard mammograms also called screening mammograms have helped save countless lives. Is the program focused mainly on saving money? Additional Screenings for High-Risk Women 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. They are regularly reviewed by physicians of appropriate specialties for consistency with the most recent medical evidence. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. So why do so many women put off their mammograms? HMO coverage is offered by Health Options, Inc. DBA Florida Blue HMO. 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 . If so, it should not impact the ability of members to receive these tests. Inscribirse ahora! All rights reserved. Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. These benefits are currently in effect unless otherwise noted. Plus, your medical plan covers 100% of the costs for preventive health services when care is provided through network providers. Linked Apps. 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. Not all participating DME vendors carry breast pumps. BSC6.07 Digital Breast Tomosynthesis. 2023 Blue Cross and Blue Shield of North Carolina. You will be required to pay the plan's physician office copayment or coinsurance. 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. Mammogram screening $0 Once per year Nutrition therapy services $0 Ongoing if high risk Learn more about our non-discrimination policy and no-cost services available to you. 18.5 - 24.9: healthy weight. 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. While 3D mammograms show some promise in better health outcomes, there isnt enough research to advocate them over 2D mammograms. 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). List of all medications that are covered at 100% onall formularies. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Focusing on the right test at the right time for the right patient could save time and mone and increase productivity. There are also additional guidelines if you're pregnant. Who Should Get It: Women age 21 - 65. Ordering physicians for Blue Cross NC members must obtain prior approval prior to scheduling an imaging exam for outpatient diagnostic, non-emergent services. If you have questions about coverage for preventive services, . Health plans are offered by Blue Shield of California. This screening is no cost to you. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. It often forms in the tubes that carry milk to the nipple (ducts) and in glands that make milk (lobules). What information is required to request prior approval? The cost of many screenings and checkups is covered at 100% with no out of pocket costs for you and those on your plan. Blue Shield of California 1999 . Forgot User ID? 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. Hysterectomies are not performed solely for sterilization so are not covered as preventive. CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval. "When a provider recommends getting screened, it indicates the risks outweigh the benefit and it is deemed to be safe," Dallow said, adding that under the . If you have an HMO or POS plan, there are some additional services you'll need approval for. Psychotherapy. We recognize that any requirements for prior plan approval for procedures place an administrative burden on physicians, and we continually evaluate such programs to assure that they deliver on promised savings to members while attempting to minimize the impact on provider offices. Assessing Your Risk Mammograms are one of the best ways to find it early. The protection of your privacy will be governed by the privacy policy of that site. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Breast cancer is the most common type of cancer in women. During this visit, your doctor examines your overall health. Immunizations for you and your family. . FDA-approved tobacco cessation prescription. Its common to receive a Pap test (also called a Pap smear or pelvic exam) during your visit. Women ages 35-39 can receive one baseline mammogram (four views). Some providers charge more, and some offer an uninsured discount. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. Bacteriuria screening for pregnant women. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Tests that do not meet national clinical guidelines will not be approved. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . Summary of Arkansas Blue Cross Blue Shield and Health Advantage Coverage Polices. Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. Screening for Breast Cancer 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. Issuance of a prior approval number is not a guarantee of payment. listed below will be covered by your plan. Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). Confirmation of silicone gel-filled breast implant ruptures, when this diagnosis cannot be confirmed by mammography or breast ultrasound; For postoperative evaluation of silicone breast implant complications. By using X-rays, they create two-dimensional images of the breast to spot suspicious tissue that may be cancerous. Am I eligible for these benefits at 100%? Approve annually starting at age 30; Individuals not yet tested for BRCA gene, but with known BRCA mutation in first degree relative. Copyright 2023 Health Care Service Corporation. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. BCBSIL Provider Manual June 2020 2 . No coverage for routine physical examinations. to expand insurance coverage for diagnostic mammograms. Preventive Care Guidelines. Copy. Pays cash if you're treated for cancer. Take advantage of preventive care and stop problems before they get serious. Who can physicians call if they have questions? Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Linked Apps. "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. Theyre covered, lifesaving and nothing to fear. . A Pap test every 3 years or. Life-Saving: Cancer detection is the key to early treatment and better outcomes. Blue Cross NC has partnered with American Imaging Management, Inc. (AIM) for the management of outpatient, high-tech diagnostic imaging services. Usage Agreement When it's preventive: You get a mammogram to check for breast cancer. 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). The average mammogram appointment is just 15 minutes long. 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. Why did Blue Cross NC implement a diagnostic imaging management program? Others have a false sense of . Did you know that one in eight women will develop invasive breast cancer at some point in her life? 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. They can help detect breast cancer up to three years before it can be felt. Breast cancer mammography screenings for women over age 40; Colorectal cancer screening for adults over age 45; . 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. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Learn more about our non-discrimination policy and no-cost services available to you. Your doctor can help you choose a facility thats convenient for you. Routine health checkups. Insurance. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Doses, recommended ages and recommended populations vary. This is very important in clinical decision making as alternative therapies may be selected based upon the results obtained from the MRI. Currently, about 12% of women will develop breast cancer at some point in their lifetime. So why do so many women put off their mammograms? 104 0 obj <> endobj Counseling. Here's a deeper dive on the potential benefits and risks of a 3D mammogram. Provider Manual . Health coverage is offered by Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. Make sure to get all the screenings and vaccines recommended for your age and gender. However, about 72% of women with BRCA1 and about 69% of women with BRCA2 will develop breast cancer by the age of 80. Should a member request This allows the whole breast to be seen. Learn more about our non-discrimination policy and no-cost services available to you. Will this program impact members' ability to receive the tests they need? The remaining 40% are out-of-pocket costs. Enroll Now. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Even if you're feeling fine, scheduling an appointment with your doctor for preventive care services is important. Routine mammograms are covered by the state health plan at no cost to you. 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. There is an appeals process in place for unfavorable determinations. About one in every seven or eight women gets it in her lifetime. Did you know preventive health measures and screenings can prevent 85% of illness and disease, and are covered at no cost for many plans? Learn the facts, and then schedule an appointment today! Frequency: May vary based on your health so ask your doctor, Certain breast pumps for pregnant and post-partum women, One manual or electric breast pump purchase per pregnancy is covered, Benefit available during third trimester (starting 11.1.16) or after member has delivered the baby, Breast pumps come with certain supplies, such as tubing, shields and bottles, Breast pumps must be purchased from participating Durable Medical Equipment (DME) vendors. Diagnostic care includes care or treatment when you have symptoms or risk factors and your doctor wants to diagnose them. Are you going to reimburse providers for the savings Blue Cross NC will incur? Help Center. However, your group may decide to delay the effective date for coverage until your group's plan . Thanks in part to preventive screenings, there are approximately 2.8 million breast cancer survivors in the U.S. as of 2016. Technical Information What imaging procedures require prior plan approval? Side-to-side and top-to-bottom images are made. AIM has a track record of successful experience working with many providers and other Blue Cross and Blue Shield plans across the country. Mammograms use very small doses of radiation and the risk of harm is very low. Only ordering physicians can obtain a prior plan approval number. In contrast, 3D mammograms use CT (computed tomography) scans. 2 The HPV vaccine (Gardasil) is covered to age 45 per the Food and Drug Administration (FDA) guidelines. A high BMI can be a warning sign for potential health problems. We use cookies on this website to give you the best experience and measure website usage. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the . If you get benefits from your employer, you may also have these benefits. Find out what preventive care services are appropriate for you and build a list to share with your doctor. Annually about 220,000 women are diagnosed with breast cancer. Blue Cross and Blue Shield Association. 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. You are viewing estimated values for an individual. 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. Routine gynecological visits. Screening mammograms every 12 months if you are a woman age 40 or older. 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.
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