blue cross blue shield mammogram coverage

Wellness service benefits pay you money*. Your member ID card is your key to using your medical plan benefits. Breast cancer mammography screenings for women over age 40; Colorectal cancer screening for adults over age 45; . Check your Benefit Booklet for details on other preventive care benefits. All women 40 or older should ask their doctor about when to start getting mammograms and how often theyre needed. This new site may be offered by a vendor or an independent third party. 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. 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. During this visit, your doctor examines your overall health. Please review the terms of use and privacy policies of the new site you will be visiting. Help Center. Your dashboard may experience future loading problems if not resolved. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. 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 . Does this prior approval impact Blue Medicare HMO and Blue Medicare PPO? Heres everything you need to know about it. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. It is important to note that these services are free only when delivered by a doctor or other . Scenario 2: Your claim for emtricitabine/tenofovir (generic Truvada) or Apretude is not paying at 100% and you are using it for PrEP. Mammograms are one of the best ways to find it early. Additionally, the increased use of some high technology imaging procedures creates patient safety concerns from radiation exposure. NRT through QuitlineNC is available without a prescription. Hospitals and freestanding imaging centers that perform the imaging services cannot obtain the approval. By continuing to use this website, you consent to these cookies. 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. Provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions. Women ages 35-39 can receive one baseline mammogram(four views). The goal of the Blue Cross NC Diagnostic Imaging Program is to improve affordability for Blue Cross NC members. For example, women who have a family history of breast, cervical or ovarian cancer can be tested for the BRCA1 or BRCA2 genes. MRI of the breast is a useful tool for the detection and characterization of breast disease, assessment of local extent of disease, evaluation of treatment response, and guidance for biopsy and localization. Breast MRI should be bilateral except for those with a history of mastectomy or when the MRI is being performed expressly to further evaluate or follow findings in one (1) breast. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. AIM has a track record of successful experience working with many providers and other Blue Cross and Blue Shield plans across the country. Your Florida Blue Medicare health plan includes a mammogram screening every year for women age 40 and over. Fraud and Abuse This screening is no cost to you. SOURCES: 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. Barium enema is a covered service but not at 100% so you may have out of pocket costs. Blue Cross and Blue Shield Association . The diagnostic imaging management program impact is low; why did Blue Cross NC implement it? 25 - 29.9: overweight. Thanks in part to preventive screenings, there are approximately 2.8 million breast cancer survivors in the U.S. as of 2016. 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. Psychotherapy. Easy: Keeping up with your screenings is an important task, even in your busy life. Health plans are offered by Blue Shield of California. Heres everything you need to know about it. Obesity screenings. There is an appeals process in place for unfavorable determinations. Preventive care includes routine well exams, screenings and immunization intended to prevent or avoid illness or other health problems. Be sure you're taking full advantage of your coverage. 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. Pays cash if you're treated for cancer. listed below will be covered by your plan. No coverage for oral contraceptive devices. No. Since their introduction, standard mammograms also called screening mammograms have helped save countless lives. Provider Manual . Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years. You have coverage from another insurance plan in addition to your Blue Cross and Blue Shield of Nebraska coverage. 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. Learn more about our non-discrimination policy and no-cost services available to you. Who reviews requests for diagnostic imaging prior approval? For most women, mammogram technology is still considered the best way to detect breast abnormalities and cancers early. These benefits are available for members of non-grandfathered individual health insurance plans. 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. What process is in place for unfavorable determinations? Nothing to fear: Its normal to feel scared before any medical procedure, but theres nothing to worry about! Prior approval is required by all facilities or settings that offer outpatient, nonemergency diagnostic imaging services. Screening for Breast Cancer 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. Make sure to get all the screenings and vaccines recommended for your age and gender. You should call the number on the back of your member ID card for more information before you schedule one. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. The policies were effective September 1, 2010 for Blue Medicare HMO and Blue Medicare PPO plans. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. Life-Saving: Cancer detection is the key to early treatment and better outcomes. http://www.breastcancer.org/symptoms/understand_bc/statistics The program is expected to assist Blue Cross NC in improving affordability for our members. . Yes. For that reason, benefits for preventive BRCA testing are available for members with a family history of certain cancers. The USPSTF recommends biennial screening mammography for . Issuance of prior approval is not a guarantee of payment. There are many easy-to-use BMI calculators online, such as this example from the Centers for Disease Control and Prevention.*. For transgendered individuals, you have access to medically appropriate preventive services. Should a member request 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. All Rights Reserved. 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. Easy: Keeping up with your screenings is an important task, even in your busy life. You should get screenings every one or two years, depending on your doctor's advice. Preventive Care. Inscribirse ahora! 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. Theyre covered, lifesaving and nothing to fear. Blue Shield of California 1999 . This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. Are you going to reimburse providers for the savings Blue Cross NC will incur? Blue Care Network HMO and POS members. 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. During this visit, your doctor examines your overall health. We use cookies on this website to give you the best experience and measure website usage. Screening for depression in postpartum women. Annual physical exams and other preventive services are free when you use a Preferred provider. Forgot Password? 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 104 0 obj <> endobj How do 3D Mammograms Differ From Standard Ones? Yes, they will cover annual mammograms if they are suitable to age. Your doctor will help you decide what schedule makes the most sense for you. Linked Apps. Register Now, Ancillary and Specialty Benefits for Employees. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Usage Agreement Council and Blue Cross and Blue Shield of . Site Map 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. 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. One option is Adobe Reader which has a built-in screen reader. Standard 2D mammograms take two pictures of the breast. In fact, we rank 32nd out of 50 states. endstream endobj 105 0 obj <. The program does not currently apply to FEP, Medicare Supplemental or Medicare Prescription Drug Plans. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography .

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