. Your member ID card is your key to using your medical plan benefits. By continuing to use this website, you consent to these cookies. Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. Mammograms are a key component of a womens preventative care. Typical costs: For an uninsured patient, typical full-price cost of a mammogram ranges from $80 to $120 or more, with an average of about $102, according to Blue Cross Blue Shield of North Carolina. NRT through the pharmacy benefit is available only with a prescription. No coverage for routine physical examinations. Examples of these services include: Initial evaluation. Mammogram screening $0 Once per year Nutrition therapy services $0 Ongoing if high risk Some state or federal mandates [e.g., Federal Employee Program (FEP)] prohibits plans from 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. All women 40 or older should ask their doctor about when to start getting mammograms and how often theyre needed. Breast cancer is the most common type of cancer in women. You must be at least 18 years old to submit a request. Fewer false alarms reduce unnecessary re-testing along with stress and worry. A mammogram uses an X-ray to examine the breast tissue and can detect changes before you can feel them. Accessibility Achieving this requires that we reduce the number of imaging examinations that do not add diagnostic value for members. Bacteriuria screening for pregnant women. During this visit, your doctor examines your overall health. Blue Cross and Blue Shield of Illinois . For women age 30-65. BSC6.07 Digital Breast Tomosynthesis. Forgot Password? We believe that it is critical to carefully examine the appropriate use of outpatient, nonemergency diagnostic imaging procedures to make sure that the benefit of the procedure outweighs the risk. HMO Scope of Benefits Section . How does Blue Cross NC ensure that the program does not negatively impact patient care, divert physicians from the practice of medicine or compromise the patient/physician relationship? %PDF-1.5 % Healthy tissue may appear suspicious and cancerous tissue can be masked. 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. If there is a medical reason you cannot use a generic statin, your doctor should review this. 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. 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. For transgendered individuals, you have access to medically appropriate preventive services. Make sure to get all the screenings and vaccines recommended for your age and gender. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. The goal of the diagnostic imaging program is to improve affordability of health care to Blue Cross NC members. Standard 2D mammograms take two pictures of the breast. 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. This is especially important for women who have dense breast tissue. 2023 Blue Cross and Blue Shield of North Carolina. Breast Cancer and Early Detection: What Women Need to Know. NRT through QuitlineNC is available without a prescription. Standard 2D mammograms take two pictures of the breast. Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room. Additional Screenings for High-Risk Women Tissue doesnt overlap. Sydney Care is offered through an arrangement with Carelon Digital Platforms, Inc. Sydney Health and Sydney Care are service marks of Carelon Digital Platforms, Inc., 2023, http://www.breastcancer.org/symptoms/understand_bc/statistics, https://www.anthem.com/health-insurance/health-care-reform-resources/reform-law-detail/more-womens-preventive-care-covered?reformlaw=l1019, http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. Technical Information "To put it in perspective, the dose of radiation is lower than that of a chest x . 4510 13th Ave. S. Regular mammograms improve survival rates by, Thanks in part to preventive screenings, there are approximately, The average mammogram appointment is just. Inscribirse ahora! If you get benefits from your employer, you may also have these benefits. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Your doctor may order a colonoscopy more frequently than every 10 years. Psychotherapy. The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue Shield of Alabama. Linked Apps. A high BMI can be a warning sign for potential health problems. Approve annually starting at age 30; Individuals not yet tested for BRCA gene, but with known BRCA mutation in first degree relative. Approve annually starting at age 30; Individuals with known BRCA mutation. This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. BATON ROUGE - October is Breast Cancer Awareness Month. Regence supports women's preventive breast health. Additional mammograms may require cost sharing. Will the diagnostic imaging management program increase the risk of malpractice? Generally, practicing consistently with national evidence-based guidelines is expected to reduce errors and liability. Reproduction without authorization from Blue Shield of California is prohibited. 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. Side-to-side and top-to-bottom images are made. Learn the facts, then schedule an appointment today! Learn more about our non-discrimination policy and no-cost services available to you. 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. It is important to note that these services are free only when delivered by a doctor or other . We apologize for any inconvenience. No. Learn more about our non-discrimination policy and no-cost services available to you. Provider Manual . Council and Blue Cross and Blue Shield of . List of all medications that are covered at 100% onall formularies. SOURCES: Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. But Humana, which I have now, is even worse because I have a $50 copay just for screening." 3. However, your group may decide to delay the effective date for coverage until your group's plan . Access Your Payment Options. Usage Agreement Your dashboard may experience future loading problems if not resolved. Some buy into dangerous myths about breast cancer. Still, over the past decade, there have been advances in mammogram technology. endstream endobj 105 0 obj <. Hospitals and freestanding imaging centers that perform the imaging services cannot obtain the approval. For most women, mammogram technology is still considered the best way to detect breast abnormalities and cancers early. 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. During this visit, your doctor examines your overall health. Women ages 40 and older can receive a mammogram (four views) each calendar year. Women who get a 3D mammogram may also get a traditional 2D mammogram, exposing them to higher amounts of radiation. Olvido su contrasea? All premiums listed represent coverage for dependents up to age 26. 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. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. Currently, under the Patient Protection and Affordable Care Act Annual Checkups and certain preventive . Fraud and Abuse However, about 72% of women with BRCA1 and about 69% of women with BRCA2 will develop breast cancer by the age of 80. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. %%EOF 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. Some women have a higher risk of developing cancer than other women. Barium enema is a covered service but not at 100% so you may have out of pocket costs. Its common to receive a Pap test (also called a Pap smear or pelvic exam) during your visit. The AIM medical guidelines are publicly available and reviewed regularly by radiologists and practicing physicians of many specialties and updated based on the most current medical evidence. No coverage for oral contraceptive devices. 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. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the . 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. Register Now, Ancillary and Specialty Benefits for Employees. HMO coverage is offered by Health Options, Inc. DBA Florida Blue HMO. "Breast cancer is the most common cancer in American women, but men can also develop breast cancer," said Blue Cross and Blue Shield of . Help Center. Your doctor can help determine your risk level and what steps you should take. Some sites may require you to agree to their terms of use and privacy policy. There are significant concerns about patient safety involved in the increased exposure to radiation due to diagnostic imaging procedures. 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. No family history, no risk. Register Now, Ancillary and Specialty Benefits for Employees. Please send us your question so a licensed agent can contact you. No lump, no cancer. Your doctor will advise on recommended immunizations that can protect against a number of serious diseases. Coverage is subject to the specific terms of the member's benefit plan. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. 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. Click on a service to see any limits or exclusions. Thanks in part to preventive screenings, there are approximately 2.8 million breast cancer survivors in the U.S. as of 2016. The site may also contain non-Medicare related information. 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. Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. Log In to the Shopping Cart, Need to Make a Payment? Why did Blue Cross NC implement a diagnostic imaging management program? 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. Screening for depression in postpartum women. It's important for adult women to have annual wellness exams after the age of 21. 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. Easy: Keeping up with your screenings is an important task, even in your busy life. Copyright 2023 Health Care Service Corporation. "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. TheU.S. Preventive Services Task Forcerecommends that women between the ages of 50 and 74 get a mammogram every two years. Women between the ages of 40 and 49 should talk to their doctor about when they should start getting mammograms. You should call the number on the back of your member ID card for more information before you schedule one. Theyll also look for early signs of breast and cervical cancer. If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this. (EOB) from Blue Shield of California to notify you that your claim has been processed. Site Map Dynamic contrast material-enhanced MRI may be used to monitor response of a tumor to neoadjuvant chemotherapy used to shrink the tumor before surgery. Heres everything you need to know about it. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . External link You are leaving this website/app (site). What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Tobacco and alcohol use evaluations. Learn the facts, and then schedule an appointment today! Mammograms use very small doses of radiation and the risk of harm is very low. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. If so, it should not impact the ability of members to receive these tests. Servicing providers (hospitals, freestanding imaging centers, etc.) Please utilize the checklist below as a guideline to ensure you have all the necessary information before requesting prior approval: For complex cases, more information may be necessary, including: The diagnostic imaging management process is based upon AIM clinical practice guidelines, developed from consensus opinion in medical practice and integration of medical information from multiple sources, including: The prior approval number will be valid for 30 days from the date issued - not the date of service requested. Anemia screening for pregnant women. There is an appeals process in place for unfavorable determinations. This allows the whole breast to be seen. The USPSTF recommends biennial screening mammography for . Select a Region: Please Select One DVEST1 DV9ST1 DV8ST1 DV5ST1 DV4ST1 DV1ST1 DVPST1 DVOST1 DVMST1 DVJST1 DVHST1 DVGST1 DVFST1 DVEST1 DVDST1 DVCST1 LOEST1 Regular mammograms improve survival rates by 35% in women over 50. 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. 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. Olvido su contrasea? Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Most breast cancers are found in women 50 years old and older. 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. Your member ID card is your key to using your medical plan benefits. Another Reason to Get Moving: Exercise Can Help Lower Cancer Risk. should confirm that a prior approval number has been issued. Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years. Blue Cross and Blue Shield Association . But a damaged or broken gene can increase the risk of developing breast cancer. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . Did you know that one in eight women will develop invasive breast cancer at some point in her life? Pays in addition to your other coverages. Find A Doctor Or Hospital In Your Network. 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. The policies were effective for diagnostic imaging services performed on or after February 15, 2007 for Blue Cross NC commercial plans. Mammograms are one of the best ways to find it early. The following contraceptive methods (devices and associated procedures, such as device removal, and pharmaceutical contraceptives) for women with reproductive capacity: Emergency contraception (i.e., morning after pill, Plan B, ella), Effective 8.1.22, one annual subscription to, a prescription from an in-network provider that includes the name of the app, Natural Cycles fertility app, Injections (only covered as preventive for Medoxyprogesterone Acetate 150 mg, which is the only drug and dosage used for contraception), Oral contraceptives (all generic contraceptives will be covered as preventive; brand oral contraceptives will continue to require member cost sharing (e.g., deductible, copay, and/or coinsurance) View a complete, OTC contraceptives (female condoms, all products; sponges, all products; spermicides, all products, male condoms effective 1.1.23), Sterilization procedures including tubal ligation (tying of fallopian tubes) and salpingectomy (removal of fallopian tubes). When it's preventive: You get a mammogram to check for breast cancer. What places or settings of treatment are affected? Screening mammograms every 12 months if you are a woman age 40 or older. 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 .