blue cross blue shield mammogram coverage

2020. . So why do so many women put off their mammograms? Learn more about our non-discrimination policy and no-cost services available to you. Doses, recommended ages and recommended populations vary. The diagnostic imaging management program impact is low; why did Blue Cross NC implement it? If you have a positive fecal blood test (gFOBT or FIT or Cologuard) or visualization test (CT colonography or sigmoidoscopy), your doctor may order a follow up colonoscopy. Additional Screenings for High-Risk Women Anemia screening for pregnant women. 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. . Counseling. The USPSTF recommends biennial screening mammography for . Your member ID card is your key to using your medical plan benefits. to expand insurance coverage for diagnostic mammograms. Fraud and Abuse However, sometimes tests are ordered and are not clinically appropriate. Ordering physicians may also contact the AIM physician reviewer at any time during the authorization process. To capture them, the breast is pulled away from the body, compressed and held between two glass plates. Cat-scan technology exposes patients to more radiation than an X-rays. Easy: Keeping up with your screenings is an important task, even in your busy life. Health Insurance Tax Information; Transparency in Coverage; Mental Health Parity; Teledentistry Services Covered; . Breast cancer mammography screenings for women over age 40; Colorectal cancer screening for adults over age 45; . You can also visit our Mental Health Resource . Call us at 1-888-243-4420 if you have questions or need help. Currently, under the Patient Protection and Affordable Care Act Annual Checkups and certain preventive . Your doctor will advise on recommended immunizations that can protect against a number of serious diseases. A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. They can help detect breast cancer up to three years before it can be felt. You usually need to get tested every 3 to 5 years. Talking with your healthcare provider about the . Routine mammograms are covered by the state health plan at no cost to you. 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. 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 . Negotiated rates with providers can change, therefore, changing the estimate. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Learn the facts, then schedule an appointment today! Additionally, the increased use of some high technology imaging procedures creates patient safety concerns from radiation exposure. Some women have a higher risk of developing cancer than other women. Breast cancer is the most common type of cancer in women. Mammograms use very small doses of radiation and the risk of harm is very low. 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. During this visit, your doctor examines your overall health. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. 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. Approve annually starting at age 30; Individuals with known BRCA mutation. 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. 2023 Blue Cross and Blue Shield of North Carolina. Select a Region: Please Select One DVEST1 DV9ST1 DV8ST1 DV5ST1 DV4ST1 DV1ST1 DVPST1 DVOST1 DVMST1 DVJST1 DVHST1 DVGST1 DVFST1 DVEST1 DVDST1 DVCST1 LOEST1 2023 Blue Cross and Blue Shield of North Carolina. hb```,z@ (Mf`X b`Fe~F9}mS6.awa`\V_RQ g-e0 %PDF-1.5 % MRI of the breast is a useful tool for the detection and characterization of breast disease, assessment of local extent of disease, evaluation of treatment response, and guidance for biopsy and localization. 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. There is an appeals process in place for unfavorable determinations. We recommend receiving estimates close to . While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram. Dental, Life and Disability are offered by Florida Combined Life . Yes, they will cover annual mammograms if they are suitable to age. Heres everything you need to know about it. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. This new site may be offered by a vendor or an independent third party. For more information, view our privacy policy. But a damaged or broken gene can increase the risk of developing breast cancer. CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval. Find out what preventive care services are appropriate for you and build a list to share with your doctor. 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. If physicians have questions about the Blue Cross NC diagnostic imaging management program, they should contact their local Network Management representatives. Breast cancer risk factors include: Check with your doctor if you have questions about mammograms or other breast cancer screenings. Prior approval is required by all facilities or settings that offer outpatient, nonemergency diagnostic imaging services. Check your Benefit Booklet for details on other preventive care benefits. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. 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. 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. You have coverage from another insurance plan in addition to your Blue Cross and Blue Shield of Nebraska coverage. It's important for adult women to have annual wellness exams after the age of 21. 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. Use the subsidy calculator to enter your own . How do 3D Mammograms Differ From Standard Ones? To view this file, you may need to install a PDF reader program. Mammogram screening $0 Once per year Nutrition therapy services $0 Ongoing if high risk Most PDF readers are a free download. Members must enroll in the multi-call program to qualify for up to 12 weeks of NRT. The average mammogram appointment is just 15 minutes long. By continuing to use this website, you consent to these cookies. Here's a deeper dive on the potential benefits and risks of a 3D mammogram. Blue Medicare HMO and Blue Medicare PPO (as of September 1, 2010). If eligible, you must receive genetic counseling and evaluation services before you receive preventive BRCA testing. Find your ideal accommodation from hundreds of great deals and save with www.trivago.com endstream endobj startxref Coverage is subject to the specific terms of the member's benefit plan. All women 40 or older should ask their doctor about when to start getting mammograms and how often theyre needed. List of all medications that are covered at 100% onall formularies. By slowing this growth and containing costs through a proactive diagnostic imaging management program, we anticipate costs savings over time. Most breast cancers are found in women 50 years old and older. recipe is no mess, no fuss and all flavor. 0 Mammograms arent as painful as you think you may feel a little pressure but it only lasts a few seconds. Approve annually starting at age 30. Approve annually starting at age 30; Individuals not yet tested for BRCA gene, but with known BRCA mutation in first degree relative. Olvido su contrasea? Mental Health Services. Mammograms are for older women. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services, medications and OTC nicotine replacement therapy (NRT), refer to the CDCs posted schedule of immunizations for more information. If you have an HMO or POS plan, there are some additional services you'll need approval for. hrHPV test only every 5 years. One of the goals of this program is to help contain health care costs. 2 The HPV vaccine (Gardasil) is covered to age 45 per the Food and Drug Administration (FDA) guidelines. Some preventive care services require that you meet . Take advantage of preventive care and stop problems before they get serious. During your visit, your doctor will perform a clinical breast exam. Access Your Payment Options. 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. should confirm that a prior approval number has been issued. Breast Cancer and Early Detection: What Women Need to Know. "To put it in perspective, the dose of radiation is lower than that of a chest x-ray," Mehta said. Description: Screening for cervical cancer. Cost estimates are based only on the coverage you have with us. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Scenario 2: Your claim for emtricitabine/tenofovir (generic Truvada) or Apretude is not paying at 100% and you are using it for PrEP. Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years. Learn more about our non-discrimination policy and no-cost services available to you. 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. You will be required to pay the plan's physician office copayment or coinsurance. Only ordering physicians can obtain a prior plan approval number. Providers can find complete instructions on how to request prior approval outlined on the diagnostic imaging procedures page. Since their introduction, standard mammograms also called screening mammograms have helped save countless lives. The goal of the diagnostic imaging program is to improve affordability of health care to Blue Cross NC members. Please update your browser if the service fails to run our website. Technical Information Some providers charge more, and some offer an uninsured discount. Should a member request If you have a higher risk for breast cancer, talk to your doctor about screening, no matter how old you are. The protection of your privacy will be governed by the privacy policy of that site. mammogram for women between ages 35-39. Even if you're feeling fine, scheduling an appointment with your doctor for preventive care services is important. Colorectal Cancer . What imaging procedures do NOT require prior approval? A Pap test every 3 years or. Pays cash if you're treated for cancer. For example, at the Kapiolani Medical Center [ 1] in Aiea, Hawaii, where the full . Log In to the Shopping Cart, Need to Make a Payment? Its common to receive a Pap test (also called a Pap smear or pelvic exam) during your visit. Screenings, tests and other preventive care services Preventive care service Cost . Connect Community - Blue Cross and Blue Shield of Illinois, Radiation treatments to the breast or chest area. Your doctor will help you decide what schedule makes the most sense for you. 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. According to the American Cancer Society, our state lags behind much of the nation in mammography screenings. 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. 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. Coverage that is supplemental to Medicare but with no member cost Depression screenings. Most PDF readers are a free download. Council and Blue Cross and Blue Shield of . TheU.S. Preventive Services Task Forcerecommends that women between the ages of 50 and 74 get a mammogram every two years. Does this prior approval impact Blue Medicare HMO and Blue Medicare PPO? We use cookies on this website to give you the best experience and measure website usage. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. 140 0 obj <>stream 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. It happens in both men and women, but breast cancer in men is not common. Nothing to fear: Its normal to feel scared before any medical procedure, but theres nothing to worry about! Learn more about our non-discrimination policy and no-cost services available to you. January 25, 2016. Blue Cross and Blue Shield Federal Employee Program Yesterday at 1:00 PM Simple yet warm, this customizable sheet pan lemon-roasted fish . Here's a deeper dive on the potential benefits and risks of a 3D mammogram. However, your group may decide to delay the effective date for coverage until your group's plan . Usage Agreement Please check your coverage with your insurance provider before your appointment with us. Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. BSC6.07 Digital Breast Tomosynthesis. A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. We apologize for any inconvenience. Non-Discrimination Statement and Foreign language Access. The age and frequency listed below are general recommendations. In addition, some sites may require you to agree to their terms of use and privacy policy. Forgot Password? To learn if your patient's plan requires prior approval for these services, please reference the diagnostic imaging procedures page. Learn the facts, and then schedule an appointment today! Blue Care Network HMO and POS members. Life-Saving: Cancer detection is the key to early treatment and better outcomes. The protection of your privacy will be governed by the privacy policy of that site. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Ordering physicians for Blue Cross NC members must obtain prior approval prior to scheduling an imaging exam for outpatient diagnostic, non-emergent services. 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. 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. Heres a deeper dive on the potential benefits and risks of a 3D mammogram.