blue cross blue shield mammogram coverage

They can help detect breast cancer up to three years before it can be felt. The protection of your privacy will be governed by the privacy policy of that site. Best Answer. This information is a reference tool and does not guarantee payment of any claims. Your coverage information in the palm of your hand. This is especially important for women who have dense breast tissue. Are you going to reimburse providers for the savings Blue Cross NC will incur? 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. You will be required to pay the plan's physician office copayment or coinsurance. If you don't see your insurance plan listed, please contact our Insurance Hotline at 469-398-4099 or email us at insuranceinfo@solismammo.com. What places or settings of treatment are affected? Imaging costs have come to the forefront for employers and health plans because they have been growing at a faster rate than other segments of medical expenditures. Cat-scan technology exposes patients to more radiation than an X-rays. 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. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. Reproduction without authorization from Blue Shield of California is prohibited. Insurance. No lump, no cancer. No prescription medication or NRT limit when received via pharmacy benefit, Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap). 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. Out of network billing can lead to unexpected charges. External link You are leaving this website/app (site). Learn more about our non-discrimination policy and no-cost services available to you. Select Your Gender. For example, women who have a family history of breast, cervical or ovarian cancer can be tested for the BRCA1 or BRCA2 genes. 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. Most PDF readers are a free download. What information is required to request prior approval? 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. Barium enema is a covered service but not at 100% so you may have out of pocket costs. 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. Heres everything you need to know about it. Enroll Now. hbbd``b` Provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions. Mammograms use very small doses of radiation and the risk of harm is very low. Learn more about our non-discrimination policy and no-cost services available to you. 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. We use cookies on this website to give you the best experience and measure website usage. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. When were Blue Cross NC's diagnostic imaging prior approval policies effective? Call us at 1-888-243-4420 if you have questions or need help. As a result, 3D mammograms lower the number of false alarms. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Check out the changes and updates to our plan in 2023. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. A high BMI can be a warning sign for potential health problems. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. Site Map For evaluation of identified lesion, mass or abnormality in breast in. For this reason, 2D mammograms can sometimes produce inaccurate findings. Screening can help find breast cancer early, when it is easier to treat. For transgendered individuals, you have access to medically appropriate preventive services. Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years. It is important to note that these services are free only when delivered by a doctor or other . 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). BATON ROUGE - October is Breast Cancer Awareness Month. 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. Mammograms arent as painful as you think you may feel a little pressure but it only lasts a few seconds. You are only exposed to a small amount of radiation during a mammogram, and studies show that the benefits of mammograms outweigh any risks. Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested. 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 Healthy tissue may appear suspicious and cancerous tissue can be masked. Should a member request Mental Health Services. However, your group may decide to delay the effective date for coverage until your group's plan . . Find out what preventive care services are appropriate for you and build a list to share with your doctor. By using X-rays, they create two-dimensional images of the breast to spot suspicious tissue that may be cancerous. For example, at the Kapiolani Medical Center [ 1] in Aiea, Hawaii, where the full . Generally, practicing consistently with national evidence-based guidelines is expected to reduce errors and liability. Why did Blue Cross NC implement a diagnostic imaging management program? 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. It may also be used to depict residual disease after neoadjuvant chemotherapy. Women ages 40 and older can receive a mammogram (four views) each calendar year. hb```,z@ (Mf`X b`Fe~F9}mS6.awa`\V_RQ g-e0 The goal of the Blue Cross NC Diagnostic Imaging Program is to improve affordability for Blue Cross NC members. Standard 2D mammograms take two pictures of the breast. "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 . Does this prior approval impact Blue Medicare HMO and Blue Medicare PPO? 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. hrHPV test only every 5 years. 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. Others have a false sense of . Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services. But a damaged or broken gene can increase the risk of developing breast cancer. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. Breast cancer is the most common type of cancer in women. 140 0 obj <>stream Pays cash if you're treated for cancer. You must also receive prior approval from us. 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. 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 . Provider Manual . No coverage for routine physical examinations. Standard 2D mammograms take two pictures of the breast. For more information, see the Blue Cross and Blue Shield Service Benefit Plan brochures. 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. 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. Find A Doctor Or Hospital In Your Network. Some state or federal mandates [e.g., Federal Employee Program (FEP)] prohibits plans from Doses, recommended ages and recommended populations vary. Please send us your question so a licensed agent can contact you. They'll also look for early signs of breast and cervical cancer. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Side-to-side and top-to-bottom images . Olvido su contrasea? Please review the terms of use and privacy policies of the new site you will be visiting. The age and frequency listed below are general recommendations. . This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs. The program is expected to assist Blue Cross NC in improving affordability for our members. You should get screenings every one or two years, depending on your doctor's advice. 30 and above: obese. For most women, mammogram technology is still considered the best way to detect breast abnormalities and cancers early. Bacteriuria screening for pregnant women. 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. Blue Care Network HMO and POS members. Pays in addition to your other coverages. The issue of return on investment and appropriateness of guidelines will be continually addressed as part of the evaluation of the program. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . You must be at least 18 years old to submit a request. 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). *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 . A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. You can also visit our Mental Health Resource . The cost estimate changed prior to your care. Negotiated rates with providers can change, therefore, changing the estimate. Not all participating DME vendors carry breast pumps. 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. Additional mammograms may require cost sharing. All women need to be informed by their healthcare provider about the best screening options for them. - 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. Breast cancer is the second leading cause of cancer deaths among women in the U.S. Talk to your doctor to find out which of these you should have based on your health. All rights reserved. Breast tomosynthesis is an . If so, it should not impact the ability of members to receive these tests. 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. However, sometimes tests are ordered and are not clinically appropriate. Your doctor will advise on recommended immunizations that can protect against a number of serious diseases. Your Florida Blue Medicare health plan includes a mammogram screening every year for women age 40 and over. We believe that it is critical to carefully examine the appropriate use of outpatient, nonemergency diagnostic imaging procedures to make sure that the benefit of the procedure outweighs the risk. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Yes. Site Map Side-to-side and top-to-bottom images . There is an appeals process in place for unfavorable determinations. Am I eligible for these benefits at 100%? Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). The American Cancer Society recommends women ages 40 to 54 get annual mammograms, and women 55 and older get screenings every two years. 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.