blue cross blue shield mammogram coverage

Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard 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 . Which health plans does the program apply to? Thanks in part to preventive screenings, there are approximately 2.8 million breast cancer survivors in the U.S. as of 2016. This screening is no cost to you. They'll also look for early signs of breast and cervical cancer. Your doctor will collect a sample of cells from your cervix to test for any abnormal or precancerous cells. 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. The USPSTF recommends biennial screening mammography for . How do 3D Mammograms Differ From Standard Ones? Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Provider Manual . One of the goals of this program is to help contain health care costs. Non-Discrimination Statement and Foreign language Access. Your member ID card is your key to using your medical plan benefits. "Breast cancer is the most common cancer in American women, but men can also develop breast cancer," said Blue Cross and Blue Shield of . 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. Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : mammograms. Mammograms: Women age 40 and older should have a screening mammogram every year and should continue to do so for as long as they are in good health. Others have a false sense of . The diagnostic imaging management program impact is low; why did Blue Cross NC implement it? Who Should Get It: Women age 21 - 65. 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. You are viewing estimated values for an individual. What imaging procedures require prior plan approval? When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. Here's how to interpret your BMI: Below 18.5: underweight. Others have a false sense of . What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. The American Cancer Society recommends women ages 40 to 54 get annual mammograms, and women 55 and older get screenings every two years. Blue Cross NC will be the fourth company to implement a diagnostic imaging program in North Carolina. It's important to note that your provider has the right to code and bill services according to his or her viewpoint. 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. Please review the terms of use and privacy policies of the new site you will be visiting. All women need to be informed by their healthcare provider about the best screening options for them. "To put it in perspective, the dose of radiation is lower than that of a chest x . Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Standard 2D mammograms take two pictures of the breast. Your doctor will help you decide what schedule makes the most sense for you. Preventive Care Guidelines. Additional mammograms may require cost sharing. "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 . Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. 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. You must also receive prior approval from us. Breast cancer is the second leading cause of cancer deaths among women in the U.S. Ordering physicians may also contact the AIM physician reviewer at any time during the authorization process. Routine mammograms are covered by the state health plan at no cost to you. When it's preventive: You get a mammogram to check for breast cancer. 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%. CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval. Coverage Information. BlueCross BlueShield of South Carolina. 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. Additionally, the increased use of some high technology imaging procedures creates patient safety concerns from radiation exposure. By continuing to use this website, you consent to these cookies. This allows the whole breast to be seen. It's important for adult women to have annual wellness exams after the age of 21. The average mammogram appointment is just 15 minutes long. For more information, view our privacy policy. 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. These benefits are available for members of non-grandfathered individual health insurance plans. Side-to-side and top-to-bottom images are made. Usage Agreement You are only exposed to a small amount of radiation during a mammogram, and studies show that the benefits of mammograms outweigh any risks. Breast cancer risk factors include: Check with your doctor if you have questions about mammograms or other breast cancer screenings. We recommend receiving estimates close to . Here's a deeper dive on the potential benefits and risks of a 3D mammogram. Standard 2D mammograms take two pictures of the breast. The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue Shield of Alabama. Annual physical exams and other preventive services are free when you use a Preferred . 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. Understand the difference between preventive and diagnostic. What are the goals of the diagnostic imaging management program? Is the program focused mainly on saving money? Most breast cancers are found in women 50 years old and older. You will be required to pay the plan's physician office copayment or coinsurance. Make sure to get all the screenings and vaccines recommended for your age and gender. Domestic Travel When traveling outside of Vermont you may need access to medical services. Examples of these services include: Initial evaluation. 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. Learn more about our non-discrimination policy and no-cost services available to you. Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years. Its important for adult women to have annual wellness exams after the age of 21. But Humana, which I have now, is even worse because I have a $50 copay just for screening." 3. 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. External link You are leaving this website/app (site). Most breast cancers are found in women 50 years old and older. 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. 30 and above: obese. Blue Cross NC has partnered with American Imaging Management, Inc. (AIM) for the management of outpatient, high-tech diagnostic imaging services. Your coverage information in the palm of your hand. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the . AIM has a track record of successful experience working with many providers and other Blue Cross and Blue Shield plans across the country. HMO coverage is offered by Health Options, Inc. DBA Florida Blue HMO. BATON ROUGE - October is Breast Cancer Awareness Month. No prescription medication or NRT limit when received via pharmacy benefit, Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap). 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. Health Insurance Tax Information; Transparency in Coverage; Mental Health Parity; Teledentistry Services Covered; . 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. Register Now, Ancillary and Specialty Benefits for Employees. Site Map Mammograms are a key component of a womens preventative care. Focusing on the right test at the right time for the right patient could save time and mone and increase productivity. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Side-to-side and top-to-bottom images . Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. There has been an error with your submission. Healthy tissue may appear suspicious and cancerous tissue can be masked. Find your ideal accommodation from hundreds of great deals and save with www.trivago.com Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room. 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. For more information, view our privacy policy. 2023 Blue Cross and Blue Shield of North Carolina. Fraud and Abuse 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. Of the 4 million women age 40 to 65 in Texas, 2.6 million . As a result, 3D mammograms lower the number of false alarms. 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) . Mammograms are one of the best ways to find it early. 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. . The policies were effective September 1, 2010 for Blue Medicare HMO and Blue Medicare PPO plans. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. For most women, mammogram technology is still considered the best way to detect breast abnormalities and cancers early. 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. Hospitals and freestanding imaging centers that perform the imaging services cannot obtain the approval. No lump, no cancer. Fargo (Headquarters) Women who get a 3D mammogram may also get a traditional 2D mammogram, exposing them to higher amounts of radiation. Blue Cross NC is very aware of the concerns about self-referral. Council and Blue Cross and Blue Shield of . One option is Adobe Reader which has a built-in screen reader. Diagnostic care includes care or treatment when you have symptoms or risk factors and your doctor wants to diagnose them. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Necesita su ID de usuario? 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. There are also additional guidelines if you're pregnant. If you have an HMO or POS plan, there are some additional services you'll need approval for. endstream endobj startxref Learn more about our non-discrimination policy and no-cost services available to you. To learn if your patient's plan requires prior approval for these services, please reference the diagnostic imaging procedures page. Enrollment in the program is automatic and available to all Blue members. All premiums listed represent coverage for dependents up to age 26. 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). A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. Screening can help find breast cancer early, when it is easier to treat. Bacteriuria screening for pregnant women. When were Blue Cross NC's diagnostic imaging prior approval policies effective? How do 3D Mammograms Differ From Standard Ones? %%EOF Life-Saving: Cancer detection is the key to early treatment and better outcomes. Blue Cross and Blue Shield Association . Breast tomosynthesis is an . Additional Screenings for High-Risk Women recipe is no mess, no fuss and all flavor. Learn more about our non-discrimination policy and no-cost services available to you. (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. Heres everything you need to know about it. For example, women who have a family history of breast, cervical or ovarian cancer can be tested for the BRCA1 or BRCA2 genes. Women ages 40 and older can receive a mammogram (four views) each calendar year. The goal of the Blue Cross NC Diagnostic Imaging Program is to improve affordability for Blue Cross NC members. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Technical Information hbbd``b` Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . Some women have a higher risk of developing cancer than other women. It happens in both men and women, but breast cancer in men is not common. 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. Limited to a 90 day supply each for two cessation efforts. Select a Region: Please Select One DVEST1 DV9ST1 DV8ST1 DV5ST1 DV4ST1 DV1ST1 DVPST1 DVOST1 DVMST1 DVJST1 DVHST1 DVGST1 DVFST1 DVEST1 DVDST1 DVCST1 LOEST1 Heres a deeper dive on the potential benefits and risks of a 3D mammogram. For evaluation of identified lesion, mass or abnormality in breast in. Disponible nicamente en ingls. should confirm that a prior approval number has been issued. Access Your Payment Options. %PDF-1.5 % For example, at the Kapiolani Medical Center [ 1] in Aiea, Hawaii, where the full . Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the . . Coverage is subject to the specific terms of the member's benefit plan. 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. 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 . You can also visit our Mental Health Resource . Fargo, N.D., 58121. BRCA is an abbreviation for the BReast CAncer gene, which is an inherited trait. Not all employer groups participate in the diagnostic imaging management program. For women with a history of gestational diabetes who are not currently pregnant and who have not previously been diagnosed with type 2 diabetes. And that means no copays, coinsurance or payment toward your deductible. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. hb```,z@ (Mf`X b`Fe~F9}mS6.awa`\V_RQ g-e0 Understanding Health Care Costs and Quality, Provider Finder -Network Selection Criteria, HMO Provider Network Important Information, Making Your Health Insurance Work For You, Prescription Drug Changes and Pharmacy Information, Machine Readable Files for Transparency in Coverage. Accessibility Click on a service to see any limits or exclusions. endstream endobj 105 0 obj <. Starting June 1, 2022, this follow up colonoscopy will be covered at 100%. Ordering physicians for Blue Cross NC members must obtain prior approval prior to scheduling an imaging exam for outpatient diagnostic, non-emergent services. The cost estimate changed prior to your care. Summary of Arkansas Blue Cross Blue Shield and Health Advantage Coverage Polices. For this reason, 2D mammograms can sometimes produce inaccurate findings. Mammogram screening $0 Once per year Nutrition therapy services $0 Ongoing if high risk Tissue doesnt overlap. Wellness service benefits pay you money*. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. If you have a higher risk for breast cancer, talk to your doctor about screening, no matter how old you are. Your dashboard may experience future loading problems if not resolved. During your visit, your doctor will perform a clinical breast exam. $300 inpatient benefits. Description: Screening for cervical cancer. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. http://www.breastcancer.org/symptoms/understand_bc/statistics 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. You should get screenings every one or two years, depending on your doctor's advice. Fraud and Abuse You are leaving this website/app ("site"). Tobacco and alcohol use evaluations. listed below will be covered by your plan. By Regence. "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present.

blue cross blue shield mammogram coverage 2023