Fewer false alarms reduce unnecessary re-testing along with stress and worry. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. 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. Forgot Password? 104 0 obj <> endobj Diagnostic mammograms more frequently than once a year, if medically necessary. Fortunately, only about 1 in 400 people have a BRCA gene. We apologize for any inconvenience. Select Your Gender. 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. Learn more about our other insurance plans and Medicare plans, or contact a sales . Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. However, your group may decide to delay the effective date for coverage until your group's plan . BSC6.07 Digital Breast Tomosynthesis. As an example, women get regular mammograms at no cost to them as a preventive screening. 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. hbbd``b` Click on a service to see any limits or exclusions. Heres everything you need to know about it. Providers can find complete instructions on how to request prior approval outlined on the diagnostic imaging procedures page. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Be sure you're taking full advantage of your coverage. Help Center. One option is Adobe Reader which has a built-in reader. Covered: Getting screened wont break the bank. You usually need to get tested every 3 to 5 years. But Humana, which I have now, is even worse because I have a $50 copay just for screening." 3. Blue Shield of California 1999 . Routine physical exams where your doctor reviews the following: This exam is prevention focused, not problem focused. Breast cancer is the most common type of cancer in women. Preventive Care Plans & Guidelines. They can help detect breast cancer up to three years before it can be felt. For evaluation of breast lesion, identifying whether single or multi-focal, in individual with diagnosed breast cancer; For evaluation of suspicious mass, lesion, distortion or abnormality of breast in individual with history of breast cancer. Routine health checkups. Why did Blue Cross NC implement a diagnostic imaging management program? Insurance. The policies were effective for diagnostic imaging services performed on or after February 15, 2007 for Blue Cross NC commercial plans. 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. Women ages 35-39 can receive one baseline mammogram (four views). Tissue doesnt overlap. Currently, about 12% of women will develop breast cancer at some point in their lifetime. Please review the terms of use and privacy policies of the new site you will be visiting. Depression screenings. This screening is no cost to you. 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. "Breast cancer is the most common cancer in American women, but men can also develop breast cancer," said Blue Cross and Blue Shield of . Of the 4 million women age 40 to 65 in Texas, 2.6 million . 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. Most PDF readers are a free download. should confirm that a prior approval number has been issued. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the . Internal Medical Policy Committee 11-19-2020 Annual Review-Title changed slightly, Internal Medical Policy Committee 11-23-2021 Annual Review-no changes in criteria, Internal Medical Policy Committee 11-29-2022 Annual Review-no changes in criteria. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Please check your coverage with your insurance provider before your appointment with us. Breast Cancer. Some buy into dangerous myths about breast cancer. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. So why do so many women put off their mammograms? Breast tomosynthesis is an . Echocardiography studies (effective for both Commercial and Blue Medicare HMO\PPO lines of business as of January 2, 2014), Member identification number, name, date of birth, and health plan, Imaging exam(s) being requested (body part, right, left or bilateral), Patient diagnosis (suspected or confirmed), Clinical symptoms/indications (intensity/duration), Results of treatment history (previous tests, duration of previous therapy, relevant clinical medical history), American Institute of Ultrasound in Medicine (AIUM), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare & Medicaid Services (CMS) Local Coverage Determinations (LCD) and National Coverage Determinations (NCD), Promoting and guiding the selection of the most appropriate and cost-effective diagnostic imaging services, Encouraging standardization of medical practice patterns and reducing variation in clinical evaluation, Curtailing the performance of inappropriate diagnostic imaging studies, Advocating biosafety issues, including reduction of clinical radiation exposure (for CT and plain film radiography), Enhancing quality of health care for diagnostic imaging studies using evidence-based medicine and outcomes research from numerous resources. Talk to your doctor to find out which of these you should have based on your health. The good news is that mammograms can catch cancer early, when its easiest to treat, even if you dont have any symptoms. American Imaging Management (AIM) was selected as a vendor in part due to their track record of creating cost savings while reducing the unnecessary administrative burden on physician offices. You can also visit our Mental Health Resource . But a damaged or broken gene can increase the risk of developing breast cancer. Since being a carrier is relatively uncommon, doctors usually only test people with a family history of breast or ovarian cancer. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. If physicians have questions about the Blue Cross NC diagnostic imaging management program, they should contact their local Network Management representatives. And that means no copays, coinsurance or payment toward your deductible. No coverage for oral contraceptive devices. Access Your Payment Options. There are also additional guidelines if you're pregnant. By Regence. Hysterectomies are not performed solely for sterilization so are not covered as preventive. All women need to be informed by their healthcare provider about the best screening options for them. What process is in place for unfavorable determinations? "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. In addition, some sites may require you to agree to their terms of use and privacy policy. To capture them, the breast is pulled away from the body, compressed and held between two glass plates. 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. The following are the recommended vaccines for women that are covered with no out of pocket cost. Theyre covered, lifesaving and nothing to fear. Scroll down to see some common services that may or may not be covered during a preventive care visit. The program does not currently apply to FEP, Medicare Supplemental or Medicare Prescription Drug Plans. Screenings, tests and other preventive care services Preventive care service Cost . 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. All Rights Reserved. Plus, your medical plan covers 100% of the costs for preventive health services when care is provided through network providers. For evaluation of identified lesion, mass or abnormality in breast in. Some buy into dangerous myths about breast cancer. The goal of the diagnostic imaging program is to improve affordability of health care to Blue Cross NC members. 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. Screening for depression in postpartum women. Currently, under the Patient Protection and Affordable Care Act Annual Checkups and certain preventive . Examples of these services include: Initial evaluation. How do 3D Mammograms Differ From Standard Ones? During this visit, your doctor examines your overall health. TheU.S. Preventive Services Task Forcerecommends that women between the ages of 50 and 74 get a mammogram every two years. 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. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Wellness service benefits pay you money*. Summary of Arkansas Blue Cross Blue Shield and Health Advantage Coverage Polices. To view this file, you may need to install a PDF reader program. Compare the prices of 26634 hotels in Ho Chi Minh City, Vietnam. Your doctor will collect a sample of cells from your cervix to test for any abnormal or precancerous cells. This information is a reference tool and does not guarantee payment of any claims. As a result, 3D mammograms lower the number of false alarms. Blue Cross Blue Shield Global Core gives Blue Cross and Blue Shield of Vermont members access to their health care benefits wherever they go - across the country and around the world. Tests that do not meet national clinical guidelines will not be approved. $X^ "@\(k'h,@7HI?NH2012|Igl ` |> No lump, no cancer. If you have questions about coverage for preventive services, . 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. Is the program focused mainly on saving money? However, some services like 3D imaging or ultrasounds may not be fully covered the same way. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. Your browser is not supported. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Side-to-side and top-to-bottom images are made. About 10% of patients who receive routine mammograms get called back for another look. What imaging procedures require prior plan approval? What imaging procedures do NOT require prior approval? Easy: Keeping up with your screenings is an important task, even in your busy life. 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. This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. NRT through QuitlineNC is available without a prescription. All premiums listed represent coverage for dependents up to age 26. Privacy Policy Fraud and Abuse Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. The remaining 40% are out-of-pocket costs. Fargo (Headquarters) 2005 - 2022 copyright of Anthem Insurance Companies, Inc. How do 3D Mammograms Differ From Standard Ones? We can send you an email with information on our health care plans. . Additionally, the increased use of some high technology imaging procedures creates patient safety concerns from radiation exposure. 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. endstream endobj startxref However, sometimes tests are ordered and are not clinically appropriate. Women ages 40 and older can receive a mammogram (four views) each calendar year. recipe is no mess, no fuss and all flavor. Obesity screenings. Linked Apps. Women between the ages of 40 and 49 should talk to their doctor about when they should start getting mammograms. Blue Cross and Blue Shield Association. Find out what preventive care services are appropriate for you and build a list to share with your doctor. Connect Community - Blue Cross and Blue Shield of Illinois, Radiation treatments to the breast or chest area. 0 "To put it in perspective, the dose of radiation is lower than that of a chest x . January 25, 2016. Approve annually starting at age 30. 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 . Your dashboard may experience future loading problems if not resolved. Disponible nicamente en ingls. Additional mammograms may require cost sharing. Breast cancer risk factors include: Check with your doctor if you have questions about mammograms or other breast cancer screenings. For transgendered individuals, you have access to medically appropriate preventive services. Select a Region: Please Select One DVEST1 DV9ST1 DV8ST1 DV5ST1 DV4ST1 DV1ST1 DVPST1 DVOST1 DVMST1 DVJST1 DVHST1 DVGST1 DVFST1 DVEST1 DVDST1 DVCST1 LOEST1 Learn more about our non-discrimination policy and no-cost services available to you. There has been an error with your submission. However, about 72% of women with BRCA1 and about 69% of women with BRCA2 will develop breast cancer by the age of 80. For this reason, 2D mammograms can sometimes produce inaccurate findings. Some preventive care services require that you meet . . Description: Screening for cervical cancer. Learn the facts, and then schedule an appointment today! . http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-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. If something is found in a preventive screening mammogram, the screening is still at no cost to the member. Use this tool to create personalized recommendations for your . Health coverage is offered by Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. Mammograms are one of the best ways to find it early. 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. Still, over the past decade, there have been advances in mammogram technology. No coverage for routine physical examinations. 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.) 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. Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. No family history, no risk. 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. Who Should Get It: Women age 21 - 65. 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. Some state or federal mandates [e.g., Federal Employee Program (FEP)] prohibits plans from Find A Doctor Or Hospital In Your Network. Regular mammograms improve survival rates by, Thanks in part to preventive screenings, there are approximately, The average mammogram appointment is just. Some sites may require you to agree to their terms of use and privacy policy. It is important to note that these services are free only when delivered by a doctor or other . Lumps can be very difficult to feel on your own, which is why its recommended that women over the age of 40 receive regular mammograms. Please send us your question so a licensed agent can contact you. They are regularly reviewed by physicians of appropriate specialties for consistency with the most recent medical evidence. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Coverage that is supplemental to Medicare but with no member cost When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. If you have an HMO or POS plan, there are some additional services you'll need approval for. List of all medications that are covered at 100% onall formularies. 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. $100 outpatient benefits. Limited to a 90 day supply each for two cessation efforts. This happens by feeling breast tissue for any lumps or abnormal areas. Still, the overall benefit of 2D and 3D breast cancer screening outweigh any potential risks linked to radiation exposure. 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. 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. 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. This can get confusing, so call your health plan before you go. Register Now, Ancillary and Specialty Benefits for Employees. 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) . 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. Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested. For most women, mammogram technology is still considered the best way to detect breast abnormalities and cancers early. Your member ID card is your key to using your medical plan benefits. We recommend receiving estimates close to . Scenario 1: Brand Truvada, Viread, or Descovy may be made available if you are clinically unable to use generic Truvada. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years. Yes. By continuing to use this website, you consent to these cookies. . In fact, we rank 32nd out of 50 states. Members must enroll in the multi-call program to qualify for up to 12 weeks of NRT. Find your ideal accommodation from hundreds of great deals and save with www.trivago.com Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Not all employer groups participate in the diagnostic imaging management program. This new site may be offered by a vendor or an independent third party. Your doctor can help determine your risk level and what steps you should take. You should call the number on the back of your member ID card for more information before you schedule one. All rights reserved. . 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. If you have a higher risk for breast cancer, talk to your doctor about screening, no matter how old you are. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . Another Reason to Get Moving: Exercise Can Help Lower Cancer Risk. Most breast cancers are found in women 50 years old and older. Doses, recommended ages and recommended populations vary. A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. Colorectal Cancer . It may also be used to depict residual disease after neoadjuvant chemotherapy. 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. 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 . Out of network billing can lead to unexpected charges. Fargo, N.D., 58121. Am I eligible for these benefits at 100%? Make sure to get all the screenings and vaccines recommended for your age and gender. They'll also look for early signs of breast and cervical cancer. Issuance of prior approval is not a guarantee of payment. When were Blue Cross NC's diagnostic imaging prior approval policies effective? We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. These benefits are available for members of non-grandfathered individual health insurance plans.