Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. Olvido su contrasea? For example, at the Kapiolani Medical Center [ 1] in Aiea, Hawaii, where the full . By using X-rays, they create two-dimensional images of the breast to spot suspicious tissue that may be cancerous. For example, women who have a family history of breast, cervical or ovarian cancer can be tested for the BRCA1 or BRCA2 genes. Some women have a higher risk of developing cancer than other women. Accessibility , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Your coverage information in the palm of your hand. to expand insurance coverage for diagnostic mammograms. Of the 4 million women age 40 to 65 in Texas, 2.6 million . Most PDF readers are a free download. Register Now, Ancillary and Specialty Benefits for Employees. Technical Information All rights reserved. For more information, view our privacy policy. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Genetic counseling and evaluation can help determine if youve inherited a BRCA mutation. Select a Region: Please Select One DVEST1 DV9ST1 DV8ST1 DV5ST1 DV4ST1 DV1ST1 DVPST1 DVOST1 DVMST1 DVJST1 DVHST1 DVGST1 DVFST1 DVEST1 DVDST1 DVCST1 LOEST1 One option is Adobe Reader which has a built-in screen reader. To view this file, you may need to install a PDF reader program. Use this tool to create personalized recommendations for your . This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. No lump, no cancer. 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. Coverage Information. Understand the difference between preventive and diagnostic. Standard 2D mammograms take two pictures of the breast. Preventive Care Guidelines. 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. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. There are also additional guidelines if you're pregnant. Learn the facts, and then schedule an appointment today! Mammograms are for older women. Regular mammograms improve survival rates by 35% in women over 50. Your browser is not supported. BlueCross BlueShield of South Carolina. Women ages 35-39 can receive one baseline mammogram(four views). 0 104 0 obj <> endobj Preventive Care. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. The USPSTF recommends biennial screening mammography for . NRT through the pharmacy benefit is available only with a prescription. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. To learn if your patient's plan requires prior approval for these services, please reference the diagnostic imaging procedures page. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. We have an obligation to our members to provide quality care at an affordable price. During this visit, your doctor examines your overall health. It's important for adult women to have annual wellness exams after the age of 21. Use the subsidy calculator to enter your own . Call us at 1-888-243-4420 if you have questions or need help. The goal of the diagnostic imaging program is to improve affordability of health care to Blue Cross NC members. No coverage for routine physical examinations. Here are some examples: Procedures that may be cosmetic, such as removing scars or excess tissue from your eyes or abdomen; Physical therapy, speech therapy and occupational therapy; Weight-reduction procedures This screening is no cost to you. For that reason, benefits for preventive BRCA testing are available for members with a family history of certain cancers. Forgot User ID? Yes, they will cover annual mammograms if they are suitable to age. Breast cancer mammography screenings for women over age 40; Colorectal cancer screening for adults over age 45; . While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram. Servicing providers (hospitals, freestanding imaging centers, etc.) Cat-scan technology exposes patients to more radiation than an X-rays. (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. 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. Learn more about our non-discrimination policy and no-cost services available to you. No. All women need to be informed by their healthcare provider about the best screening options for them. Currently, about 12% of women will develop breast cancer at some point in their lifetime. 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) . Breast cancer risk factors include: Check with your doctor if you have questions about mammograms or other breast cancer screenings. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. It may also be used to depict residual disease after neoadjuvant chemotherapy. Necesita su ID de usuario? Additional Screenings for High-Risk Women Preventive Care Plans & Guidelines. Some Blue Cross NCmembers who are employees of religious organizations and their dependents: Talk to your employer or check your benefit booklet to confirm your coverage for these benefits and any limitations. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. 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. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. All Rights Reserved. Diagnostic care includes care or treatment when you have symptoms or risk factors and your doctor wants to diagnose them. Regence supports women's preventive breast health. 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. Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. Mammograms use very small doses of radiation and the risk of harm is very low. 140 0 obj <>stream As always, be sure to check your specific plan coverage and see an in-network provider. %%EOF Your dashboard may experience future loading problems if not resolved. Please check your coverage with your insurance provider before your appointment with us. 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. The site may also contain non-Medicare related information. However, about 72% of women with BRCA1 and about 69% of women with BRCA2 will develop breast cancer by the age of 80. Additionally, the increased use of some high technology imaging procedures creates patient safety concerns from radiation exposure. There are significant concerns about patient safety involved in the increased exposure to radiation due to diagnostic imaging procedures. (EOB) from Blue Shield of California to notify you that your claim has been processed. The policies were effective for diagnostic imaging services performed on or after February 15, 2007 for Blue Cross NC commercial plans. . Should a member request . Find an in-network doctor for preventive care. 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 . Women ages 40 and older can receive a mammogram (four views) each calendar year. Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. Select Your Gender. Returning Shopper? Be sure you're taking full advantage of your coverage. We apologize for any inconvenience. Screening for depression in postpartum women. Heres a deeper dive on the potential benefits and risks of a 3D mammogram. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Fraud and Abuse 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. No coverage for oral contraceptive devices. 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. This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. This Bronze standard plan premium covers 60% of costs. recipe is no mess, no fuss and all flavor. Dynamic contrast material-enhanced MRI may be used to monitor response of a tumor to neoadjuvant chemotherapy used to shrink the tumor before surgery. Hospitals and freestanding imaging centers that perform the imaging services cannot obtain the approval. Under the Affordable Care Act (ACA), CareFirst and other health insurance carriers must cover a set of preventive serviceslike shots and screening testsand no cost to you. 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. One its drawbacks is breast tissue can overlap during compression. Heres everything you need to know about it. 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 If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. 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. Fewer false alarms reduce unnecessary re-testing along with stress and worry. Approve annually starting at age 30; Individuals with known BRCA mutation. Sydney Care is offered through an arrangement with Carelon Digital Platforms, Inc. Sydney Health and Sydney Care are service marks of Carelon Digital Platforms, Inc., 2023, http://www.breastcancer.org/symptoms/understand_bc/statistics, https://www.anthem.com/health-insurance/health-care-reform-resources/reform-law-detail/more-womens-preventive-care-covered?reformlaw=l1019, http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. The site may also contain non-Medicare related information. Women between the ages of 40 and 49 should talk to their doctor about when they should start getting mammograms. Annual physical exams and other preventive services are free when you use a Preferred . For more information, see the Blue Cross and Blue Shield Service Benefit Plan brochures. During this visit, your doctor examines your overall health. hbbd``b` All women 40 or older should ask their doctor about when to start getting mammograms and how often theyre needed. Forgot Password? Health Insurance Tax Information; Transparency in Coverage; Mental Health Parity; Teledentistry Services Covered; . 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. 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%. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. In contrast, 3D mammograms use CT (computed tomography) scans. Currently, under the Patient Protection and Affordable Care Act Annual Checkups and certain preventive . Blue Cross NC has partnered with American Imaging Management, Inc. (AIM) for the management of outpatient, high-tech diagnostic imaging services. 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. . Please send us your question so a licensed agent can contact you. Who can physicians call if they have questions? 2020. . What imaging procedures do NOT require prior approval? Fraud and Abuse You must be at least 18 years old to submit a request. $300 inpatient benefits. 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. Side-to-side and top-to-bottom images . You should call the number on the back of your member ID card for more information before you schedule one. In addition, some sites may require you to agree to their terms of use and privacy policy. Combined together, the X-rays create a three-dimensional picture of each breast. As an example, women get regular mammograms at no cost to them as a preventive screening. Log In to the Shopping Cart, Need to Make a Payment? All premiums listed represent coverage for dependents up to age 26. Some state or federal mandates [e.g., Federal Employee Program (FEP)] prohibits plans from 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. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. Your coverage may vary from the types of benefits listed below. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Limited to a 90 day supply each for two cessation efforts. Your member ID card is your key to using your medical plan benefits. Routine gynecological visits. Fargo (Headquarters) By continuing to use this website, you consent to these cookies. Our goal is to review diagnostic imaging tests to determine if each test is clinically appropriate for the specific situation. Council and Blue Cross and Blue Shield of . 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. 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 . They are regularly reviewed by physicians of appropriate specialties for consistency with the most recent medical evidence. 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. HMO Scope of Benefits Section . 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. Domestic Travel When traveling outside of Vermont you may need access to medical services. Your member ID card is your key to using your medical plan benefits. 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. Your doctor will advise on recommended immunizations that can protect against a number of serious diseases. The average mammogram appointment is just 15 minutes long. 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. What information is required to request prior approval? Covered: Getting screened wont break the bank. 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. Disponible nicamente en ingls. Talking with your healthcare provider about the . Summary of Arkansas Blue Cross Blue Shield and Health Advantage Coverage Polices. Best Answer. Do practicing North Carolina physicians have input into the program? So why do so many women put off their mammograms? If eligible, you must receive genetic counseling and evaluation services before you receive preventive BRCA testing. Plus, your medical plan covers 100% of the costs for preventive health services when care is provided through network providers. It happens in both men and women, but breast cancer in men is not common. Additionally, we cover computer-assisted detection for those women who seek an extra level of screening for breast cancer. Annual physical exams and other preventive services are free when you use a Preferred provider. 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. 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. 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. Make sure to get all the screenings and vaccines recommended for your age and gender. Colorectal Cancer . Forgot User ID? Download the BCBSIL App. If you have a higher risk for breast cancer, talk to your doctor about screening, no matter how old you are. Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. MRI findings should be correlated with clinical history, physical examination results, and the results of mammography and any other prior breast imaging. Theyre covered, lifesaving and nothing to fear. It is important to note that these services are free only when delivered by a doctor or other . 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.

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