Scroll down to see some common services that may or may not be covered during a preventive care visit. Preventive Service Benefits - Bcbsal.org You should call the number on the back of your member ID card for more information before you schedule one. mammogram for women between ages 35-39. Inscribirse ahora! Do practicing North Carolina physicians have input into the program? We apologize for any inconvenience. 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. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). Site Map Its common to receive a Pap test (also called a Pap smear or pelvic exam) during your visit. Mammograms are one of the best ways to find it early. Breast cancer is the most widely found cancer in U.S. women, next to skin cancer. However, your group may decide to delay the effective date for coverage until your group's plan . Diagnostic care includes care or treatment when you have symptoms or risk factors and your doctor wants to diagnose them. Health coverage is offered by Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. There is an appeals process in place for unfavorable determinations. 1 If you have gotten one dose of Zostavax vaccine for shingles, you should also get the two doses of Shingrix vaccine. How should providers request prior approval? The protection of your privacy will be governed by the privacy policy of that site. 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. Know the Difference Between a Preventive and Diagnostic - Florida Blue Learn more about our non-discrimination policy and no-cost services available to you. So why do so many women put off their mammograms? 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) . Still, over the past decade, there have been advances in mammogram technology. 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. What information is required to request prior approval? Coverage is subject to the specific terms of the member's benefit plan. Fraud and Abuse Most PDF readers are a free download. During this visit, your doctor examines your overall health. Blue Cross and Blue Shield Service Benefit Plan brochures, https://www.mayoclinic.org/tests-procedures/brca-gene-test/about/pac-20384815. 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 . The policies were effective for diagnostic imaging services performed on or after February 15, 2007 for Blue Cross NC commercial plans. http://www.breastcancer.org/symptoms/understand_bc/statistics However, some services like 3D imaging or ultrasounds may not be fully covered the same way. Talk to your doctor to find out which of these you should have based on your health. (EOB) from Blue Shield of California to notify you that your claim has been processed. How do 3D Mammograms Differ From Standard Ones? Blue Cross NC has partnered with American Imaging Management, Inc. (AIM) for the management of outpatient, high-tech diagnostic imaging services. We have an obligation to our members to provide quality care at an affordable price. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. You are only exposed to a small amount of radiation during a mammogram, and studies show that the benefits of mammograms outweigh any risks. 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. Ordering physicians for Blue Cross NC members must obtain prior approval prior to scheduling an imaging exam for outpatient diagnostic, non-emergent services. The USPSTF recommends biennial screening mammography for . Dynamic contrast material-enhanced MRI may be used to monitor response of a tumor to neoadjuvant chemotherapy used to shrink the tumor before surgery. Women ages 40 and older can receive a mammogram (four views) each calendar year. Please enter a valid date of birth (MM/DD/YYYY), Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years. Returning Shopper? Plus, your medical plan covers 100% of the costs for preventive health services when care is provided through network providers. Fewer false alarms reduce unnecessary re-testing along with stress and worry. Your doctor can help you choose a facility thats convenient for you. By slowing this growth and containing costs through a proactive diagnostic imaging management program, we anticipate costs savings over time. For more information, view our privacy policy. No family history, no risk. And that means no copays, coinsurance or payment toward your deductible. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Reproduction without authorization from Blue Shield of California is prohibited. Are you going to reimburse providers for the savings Blue Cross NC will incur? 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. Your browser is not supported. BSC6.07 Digital Breast Tomosynthesis - Blue Shield of California Learn more about our non-discrimination policy and no-cost services available to you. Accepted Insurances at Solis Mammography | Solis Mammography Heres a deeper dive on the potential benefits and risks of a 3D mammogram. It often forms in the tubes that carry milk to the nipple (ducts) and in glands that make milk (lobules). Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram. Heres everything you need to know about it. Will the diagnostic imaging management program increase the risk of malpractice? HMO Scope of Benefits Section . That's No Excuse: It's Time to Get a Mammogram | Blue Cross Blue Shield Most basis mammogram screenings are covered by your health plan. Member Coverage | BlueCross BlueShield of Vermont Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. Fortunately, only about 1 in 400 people have a BRCA gene. Domestic Travel When traveling outside of Vermont you may need access to medical services. Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : mammograms. 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 Medicare PPO plans): Prior approval is not required when these procedures are performed in an emergency room, hospital (related to an inpatient or observation stay), urgent care center or ambulatory surgical center. https://www.anthem.com/health-insurance/health-care-reform-resources/reform-law-detail/more-womens-preventive-care-covered?reformlaw=l1019 endstream endobj 105 0 obj <. Some sites may require you to agree to their terms of use and privacy policy. Mammograms are for older women. All rights reserved. $300 inpatient benefits. Currently, about 12% of women will develop breast cancer at some point in their lifetime. Annual physical exams and other preventive services are free when you use a Preferred . Women ages 35-39 can receive one baseline mammogram (four views). Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography (e.g., extremely or heterogeneously dense breasts, implants); A breast cancer risk assessment (by the Gail risk or other validated breast cancer risk assessment models) that identifies the individual as having a lifetime risk of 20% or greater of developing breast cancer (approve annually); Two (2) or more first degree relatives (parents, siblings, and children) have history of breast cancer; Individuals with histories of extensive chest irradiation (usually as treatment for Hodgkin's or other lymphoma.) 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). 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. Has Blue Cross NC considered disallowing self-referrals? Your doctor can help determine your risk level and what steps you should take. "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. Description: Screening for cervical cancer. SOURCES: The cost estimate changed prior to your care. Data shows that roughly 30-40% of imaging exams are considered clinically inappropriate or noncontributory. . Support Transgender services | Blue Cross Blue Shield of Massachusetts Take advantage of preventive care and stop problems before they get serious. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. Your doctor will help you decide what schedule makes the most sense for you. According to the American Cancer Society, our state lags behind much of the nation in mammography screenings. . Who can physicians call if they have questions? This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. Scenario 1: Brand Truvada, Viread, or Descovy may be made available if you are clinically unable to use generic Truvada. Check out the changes and updates to our plan in 2023. Breast cancer is the second leading cause of cancer deaths among women in the U.S. Starting June 1, 2022, this follow up colonoscopy will be covered at 100%. 25 - 29.9: overweight. Preventive Care Plans & Guidelines. Health Insurance Tax Information; Transparency in Coverage; Mental Health Parity; Teledentistry Services Covered; . Learn the facts, and then schedule an appointment today! Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. Help Center. Mammograms are a key component of a womens preventative care. BATON ROUGE - October is Breast Cancer Awareness Month. 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. There are significant concerns about patient safety involved in the increased exposure to radiation due to diagnostic imaging procedures. Cost estimates are based only on the coverage you have with us. Health Focus: Breast Cancer Prevention | Blue Cross Blue Shield of Alabama Bronze Standard - Individual & Family Health Plans 2021 - BCBSWNY As a result, we believe that Blue Cross NC is taking an important step for patient safety and in managing increased costs by implementing a diagnostic imaging managing program. Hospitals and freestanding imaging centers that perform the imaging services cannot obtain the approval. No coverage for routine physical examinations. Your doctor may order a colonoscopy more frequently than every 10 years. Examples of these services include: Initial evaluation. Your doctor will advise on recommended immunizations that can protect against a number of serious diseases. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. Most breast cancers are found in women 50 years old and older. Women ages 40 and older can receive a mammogram (four views) each calendar year. Assessing Your Risk Nothing to fear: Its normal to feel scared before any medical procedure, but theres nothing to worry about! Usage Agreement Please review the terms of use and privacy policies of the new site you will be visiting. BSC6.07 Digital Breast Tomosynthesis. AIM has a track record of successful experience working with many providers and other Blue Cross and Blue Shield plans across the country. When it's preventive: You get a mammogram to check for breast cancer. Please send us your question so a licensed agent can contact you. Disponible nicamente en ingls. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. By using X-rays, they create two-dimensional images of the breast to spot suspicious tissue that may be cancerous. Based on clinical criteria, AIM will issue a prior approval number or will forward requests to a nurse or physician if they require further review. By Regence. Some providers charge more, and some offer an uninsured discount. 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.