blue cross blue shield mammogram coverage

Easy: Keeping up with your screenings is an important task, even in your busy life. Heres everything you need to know about it. This screening is no cost to you. 104 0 obj <> endobj No family history, no risk. Breast cancer mammography screenings for women over age 40; Colorectal cancer screening for adults over age 45; . During this visit, your doctor examines your overall health. Tobacco and alcohol use evaluations. Breast cancer is the most widely found cancer in U.S. women, next to skin cancer. 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. Accessibility Mammograms are one of the best ways to find it early. One option is Adobe Reader which has a built-in screen reader. Out of network billing can lead to unexpected charges. 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 Your doctor can help you choose a facility thats convenient for you. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. To view this file, you may need to install a PDF reader program. 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. Blue Cross NC is very aware of the concerns about self-referral. Pays cash if you're treated for cancer. Diagnostic mammograms more frequently than once a year, if medically necessary. Currently, under the Patient Protection and Affordable Care Act Annual Checkups and certain preventive . But a damaged or broken gene can increase the risk of developing breast cancer. Best Answer. 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. Blue Medicare HMO and Blue Medicare PPO (as of September 1, 2010). For example, at the Kapiolani Medical Center [ 1] in Aiea, Hawaii, where the full . The good news is that mammograms can catch cancer early, when its easiest to treat, even if you dont have any symptoms. Yes, they will cover annual mammograms if they are suitable to age. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. But Humana, which I have now, is even worse because I have a $50 copay just for screening." 3. Most breast cancers are found in women 50 years old and older. Learn more about our other insurance plans and Medicare plans, or contact a sales . 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. 2023 Blue Cross and Blue Shield of North Carolina. (EOB) from Blue Shield of California to notify you that your claim has been processed. Compare the prices of 26634 hotels in Ho Chi Minh City, Vietnam. The protection of your privacy will be governed by the privacy policy of that site. Still, the overall benefit of 2D and 3D breast cancer screening outweigh any potential risks linked to radiation exposure. Click on a service to see any limits or exclusions. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Ordering physicians for Blue Cross NC members must obtain prior approval prior to scheduling an imaging exam for outpatient diagnostic, non-emergent services. How should providers request prior approval? 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 is subject to the specific terms of the member's benefit plan. The remaining 40% are out-of-pocket costs. Your doctor will advise on recommended immunizations that can protect against a number of serious diseases. AIM has a track record of successful experience working with many providers and other Blue Cross and Blue Shield plans across the country. 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. A mammogram uses an X-ray to examine the breast tissue and can detect changes before you can feel them. 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. You will be required to pay the plan's physician office copayment or coinsurance. For more information, view our privacy policy. Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. Breast Cancer. Scenario 1: Brand Truvada, Viread, or Descovy may be made available if you are clinically unable to use generic Truvada. How do 3D Mammograms Differ From Standard Ones? 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. You are leaving this website/app ("site"). 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 following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue Shield of Alabama. For example, women who have a family history of breast, cervical or ovarian cancer can be tested for the BRCA1 or BRCA2 genes. Its common to receive a Pap test (also called a Pap smear or pelvic exam) during your visit. What process is in place for unfavorable determinations? 0 A high BMI can be a warning sign for potential health problems. Why did Blue Cross NC implement a diagnostic imaging management program? 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. Breast cancer is the second leading cause of cancer deaths among women in the U.S. All women need to be informed by their healthcare provider about the best screening options for them. Fraud and Abuse It's important to note that your provider has the right to code and bill services according to his or her viewpoint. Pays in addition to your other coverages. Additional Screenings for High-Risk Women Most PDF readers are a free download. 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. Since being a carrier is relatively uncommon, doctors usually only test people with a family history of breast or ovarian cancer. "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. Your dashboard may experience future loading problems if not resolved. As North Dakotans, we can do better in checking for breast cancer. For more information, view our privacy policy. Examples of these services include: Initial evaluation. You should get screenings every one or two years, depending on your doctor's advice. Non-Discrimination Statement and Foreign language Access. Use the subsidy calculator to enter your own . Blue Cross and Blue Shield Association . Still, over the past decade, there have been advances in mammogram technology. Heres everything you need to know about it. Routine mammograms are covered by the state health plan at no cost to you. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Coverage Information. 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. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Focusing on the right test at the right time for the right patient could save time and mone and increase productivity. Talk to your doctor to find out which of these you should have based on your health. https://www.anthem.com/health-insurance/health-care-reform-resources/reform-law-detail/more-womens-preventive-care-covered?reformlaw=l1019 BSC6.07 Digital Breast Tomosynthesis. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. They can help detect breast cancer up to three years before it can be felt. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. If you have questions about coverage for preventive services, . You usually need to get tested every 3 to 5 years. Generally, practicing consistently with national evidence-based guidelines is expected to reduce errors and liability. Standard 2D mammograms take two pictures of the breast. Blue Care Network HMO and POS members. Of the 4 million women age 40 to 65 in Texas, 2.6 million . For transgendered individuals, you have access to medically appropriate preventive services. Screening for high cholesterol is also covered at 100% every 5 years or annually for those with increased risk for CVD. Dental, Life and Disability are offered by Florida Combined Life . $300 inpatient benefits. You are only exposed to a small amount of radiation during a mammogram, and studies show that the benefits of mammograms outweigh any risks. Who reviews requests for diagnostic imaging prior approval? Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. In contrast, 3D mammograms use CT (computed tomography) scans. Standard 2D mammograms take two pictures of the breast. List of all medications that are covered at 100% onall formularies. Olvido su contrasea? Genetic counseling and evaluation can help determine if youve inherited a BRCA mutation. Women ages 35-39 can receive one baseline mammogram (four views). 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. Most Florida Blue plans cover annual screening mammograms for women age 40 and older for as low as a $0 copay.