blue cross blue shield mammogram coverage

Preventive Care. A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. Not all employer groups participate in the diagnostic imaging management program. 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). For example, at the Kapiolani Medical Center [ 1] in Aiea, Hawaii, where the full . hbbd``b` Make sure to get all the screenings and vaccines recommended for your age and gender. CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval. Provider Manual . The policies were effective September 1, 2010 for Blue Medicare HMO and Blue Medicare PPO plans. Not all participating DME vendors carry breast pumps. A Pap test every 3 years or. The good news is that mammograms can catch cancer early, when its easiest to treat, even if you dont have any symptoms. Site Map If physicians have questions about the Blue Cross NC diagnostic imaging management program, they should contact their local Network Management representatives. According to the American Cancer Society, our state lags behind much of the nation in mammography screenings. Dental, Life and Disability are offered by Florida Combined Life . A follow-up study may be considered medically necessary to help evaluate an individual's progress after treatment, procedure, intervention or surgery. 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 . 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. Here's a deeper dive on the potential benefits and risks of a 3D mammogram. Annual physical exams and other preventive services are free when you use a Preferred . To view this file, you may need to install a PDF reader program. Find your ideal accommodation from hundreds of great deals and save with www.trivago.com The program is expected to assist Blue Cross NC in improving affordability for our members. You are only exposed to a small amount of radiation during a mammogram, and studies show that the benefits of mammograms outweigh any risks. As North Dakotans, we can do better in checking for breast cancer. What places or settings of treatment are affected? Technical Information Copy. 2020. . It's important for adult women to have annual wellness exams after the age of 21. The AIM physician reviewer may contact the ordering physician to discuss the case in greater detail within two (2) business days of receipt of the request. endstream endobj startxref Scroll down to see some common services that may or may not be covered during a preventive care visit. Screening for high cholesterol is also covered at 100% every 5 years or annually for those with increased risk for CVD. Mammograms arent as painful as you think you may feel a little pressure but it only lasts a few seconds. 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%. We use cookies on this website to give you the best experience and measure website usage. The USPSTF recommends biennial screening mammography for . Fraud and Abuse Mammograms are for older women. Your dashboard may experience future loading problems if not resolved. Forgot Password? Blue Medicare HMO and Blue Medicare PPO (as of September 1, 2010). Still, the overall benefit of 2D and 3D breast cancer screening outweigh any potential risks linked to radiation exposure. Use this tool to create personalized recommendations for your . 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 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 . 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. Disponible nicamente en ingls. 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. Data shows that roughly 30-40% of imaging exams are considered clinically inappropriate or noncontributory. About 10% of patients who receive routine mammograms get called back for another look. They'll also look for early signs of breast and cervical cancer. Barium enema is a covered service but not at 100% so you may have out of pocket costs. Best Answer. Technical Information 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. "To put it in perspective, the dose of radiation is lower than that of a chest x-ray," Mehta said. Returning Shopper? In fact, we rank 32nd out of 50 states. The American Cancer Society recommends women ages 40 to 54 get annual mammograms, and women 55 and older get screenings every two years. You must be at least 18 years old to submit a request. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services. 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. Preventive care includes routine well exams, screenings and immunization intended to prevent or avoid illness or other health problems. Reimbursement Policy: Screening and Diagnostic Mammography & 3D Tomosynthesis Effective Date: April 15, 2017 Last Reviewed Date: February 14, 2023 Purpose: Provide guidelines for the processing of claims for multiple mammograms, CAD and Digital Breast Tomosynthesis (DBT) to align with recent changes to CMS' position on screening and diagnostic mammograms and to define what a mammographic . Blue Cross NC is very aware of the concerns about self-referral. 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. For this reason, 2D mammograms can sometimes produce inaccurate findings. One of the goals of this program is to help contain health care costs. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. By continuing to use this website, you consent to these cookies. The Federal Patient Protection and Preventive Care Act (PPACA) was passed by Congress and signed into law by the President in March 2010. . MRI findings should be correlated with clinical history, physical examination results, and the results of mammography and any other prior breast imaging. Achieving this requires that we reduce the number of imaging examinations that do not add diagnostic value for members. All women 40 or older should ask their doctor about when to start getting mammograms and how often theyre needed. Enrollment in the program is automatic and available to all Blue members. Who can physicians call if they have questions? Mammograms use very small doses of radiation and the risk of harm is very low. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. For transgendered individuals, you have access to medically appropriate preventive services. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. Another Reason to Get Moving: Exercise Can Help Lower Cancer Risk. Your doctor will help you decide what schedule makes the most sense for you. Prior approval is required by all facilities or settings that offer outpatient, nonemergency diagnostic imaging services. 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. Nothing to fear: Its normal to feel scared before any medical procedure, but theres nothing to worry about! %%EOF When it's preventive: You get a mammogram to check for breast cancer. You should call the number on the back of your member ID card for more information before you schedule one. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Fewer false alarms reduce unnecessary re-testing along with stress and worry. Approve annually starting at age 30; Individuals with known BRCA mutation. recipe is no mess, no fuss and all flavor. This is especially important for women who have dense breast tissue. Reproduction without authorization from Blue Shield of California is prohibited. $100 outpatient benefits. Coverage is subject to the specific terms of the member's benefit plan. Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. 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. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. This can get confusing, so call your health plan before you go. Women ages 40 and older can receive a mammogram (four views) each calendar year. hrHPV test only every 5 years. Colorectal Cancer . Breast cancer is the second leading cause of cancer deaths among women in the U.S. Find out what preventive care services are appropriate for you and build a list to share with your doctor. 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. Who Should Get It: Women age 40 and older, Who Should Get It: Age 50 - 80 and high risk due to smoking or other exposure, Who Should Get It: Age 10 - 24 with fair skin, Who Should Get It:Women who have personal or family history of breast, ovarian, tubal or peritoneal cancer or ancestry associated with breast cancer susceptibility, Who Should Get It:High-risk women age 35 and older without a prior diagnosis of breast cancer, ductal carcinoma in situ, or lobular carcinoma in situ, Who Should Get It:Women age 5059 under certain conditions, Who Should Get It:Adults aged 35 to 70 who are overweight or obese; certain women after pregnancy, Who Should Get It: Age 18 and older if at increased risk, Who Should Get It:Women age 65 and older, younger high-risk women, Who Should Get It:Adults aged 40-75 with certain risk factors, Who Should Get It:Pregnant women/women who have delivered a baby recently, Who Should Get It:Pregnant women at high risk for Preeclampsia, Who Should Get It: Pregnant and postpartum women, Who Should Get It: Women planning or capable of pregnancy, 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 who are sexually active or thinking about becoming sexually active. No coverage for routine physical examinations. Some preventive care services require that you meet . Breast tomosynthesis is an . If eligible, you must receive genetic counseling and evaluation services before you receive preventive BRCA testing. Starting June 1, 2022, this follow up colonoscopy will be covered at 100%. Register Now, Ancillary and Specialty Benefits for Employees. We apologize for any inconvenience. You must also receive prior approval from us. Privacy Policy They can help detect breast cancer up to three years before it can be felt. As always, be sure to check your specific plan coverage and see an in-network provider. Mammography is highly regulated by the Food and Drug Administration, the Mammography Quality and Standards Act and other governing organizations like the American College of Radiology. Your member ID card is your key to using your medical plan benefits. Talking with your healthcare provider about the . This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. HMO Scope of Benefits Section . Forgot User ID? 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. Easy: Keeping up with your screenings is an important task, even in your busy life. Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : mammograms. NRT through the pharmacy benefit is available only with a prescription. Some buy into dangerous myths about breast cancer. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. Domestic Travel When traveling outside of Vermont you may need access to medical services. A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. New health problems discussed with your doctor during your visit, Diagnoses that need to be addressed such as high blood pressure, diabetes, skin rash, and headaches, Breast cancer mammography screenings for women over age 40, Colorectal cancer screening for adults over age 45, Cholesterol screening for adults of certain ages or at higher risk, Additional testing and follow-up procedures if abnormalities are found during mammography or colorectal cancer screenings, Request for a vitamin Dlevel check to test for bone and muscle development and function, Request for a vaccination filter test to determine acceptable amounts of vaccine antibodies in the bloodstream. The cost estimate changed prior to your care. 18.5 - 24.9: healthy weight. Side-to-side and top-to-bottom images . Ordering physicians may also contact the AIM physician reviewer at any time during the authorization process. Click on a service to see any limits or exclusions. So why do so many women put off their mammograms? All premiums listed represent coverage for dependents up to age 26. Additional Screenings for High-Risk Women Scenario 1: Brand Truvada, Viread, or Descovy may be made available if you are clinically unable to use generic Truvada. Learn more about our non-discrimination policy and no-cost services available to you. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. How should providers request prior approval? Learn the facts, then schedule an appointment today! No. Screening for depression in postpartum women. Am I eligible for these benefits at 100%? NRT through QuitlineNC is available without a prescription. Inscribirse ahora! One option is Adobe Reader which has a built-in reader. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. Coverage that is supplemental to Medicare but with no member cost When were Blue Cross NC's diagnostic imaging prior approval policies effective? Register Now, Ancillary and Specialty Benefits for Employees. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Regular mammograms improve survival rates by 35% in women over 50.