blue cross blue shield mammogram coverage blue cross blue shield mammogram coverage

Understand the difference between preventive and diagnostic. A mammogram uses an X-ray to examine the breast tissue and can detect changes before you can feel them. Breast Cancer. 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. Technical Information Has Blue Cross NC considered disallowing self-referrals? As North Dakotans, we can do better in checking for breast cancer. Please review the terms of use and privacy policies of the new site you will be visiting. Are you going to reimburse providers for the savings Blue Cross NC will incur? You must also receive prior approval from us. Accessibility Breast cancer risk factors include: Check with your doctor if you have questions about mammograms or other breast cancer screenings. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. Coverage is subject to the specific terms of the member's benefit plan. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. BSC6.07 Digital Breast Tomosynthesis. Inscribirse ahora! Please send us your question so a licensed agent can contact you. However, some services like 3D imaging or ultrasounds may not be fully covered the same way. 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. Barium enema is a covered service but not at 100% so you may have out of pocket costs. All women 40 or older should ask their doctor about when to start getting mammograms and how often theyre needed. Theyre covered, lifesaving and nothing to fear. Women ages 40 and older can receive a mammogram (four views) each calendar year. The diagnostic imaging management program impact is low; why did Blue Cross NC implement it? The policies were effective for diagnostic imaging services performed on or after February 15, 2007 for Blue Cross NC commercial plans. 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. Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : mammograms. Your coverage may vary from the types of benefits listed below. Coverage that is supplemental to Medicare but with no member cost Covered: Getting screened wont break the bank. Blue Cross NC is very aware of the concerns about self-referral. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. To learn if your patient's plan requires prior approval for these services, please reference the diagnostic imaging procedures page. File is in portable document format (PDF). During this visit, your doctor examines your overall health. 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. (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. 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. Heres everything you need to know about it. 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. 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 . Inscribirse ahora! Learn the facts, and then schedule an appointment today! For more information, view our privacy policy. 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. HMO Scope of Benefits Section . Check out the changes and updates to our plan in 2023. Necesita su ID de usuario? Here's a deeper dive on the potential benefits and risks of a 3D mammogram. The program is expected to assist Blue Cross NC in improving affordability for our members. Some preventive care services require that you meet . Others have a false sense of . If you have questions about coverage for preventive services, . However, sometimes tests are ordered and are not clinically appropriate. If there is a medical reason you cannot use a generic statin, your doctor should review this. Select Your Gender. The good news is that mammograms can catch cancer early, when its easiest to treat, even if you dont have any symptoms. Standard 2D mammograms take two pictures of the breast. One its drawbacks is breast tissue can overlap during compression. Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years. NRT through QuitlineNC is available without a prescription. Register Now, Ancillary and Specialty Benefits for Employees. Please check your coverage with your insurance provider before your appointment with us. What imaging procedures require prior plan approval? Even if you're feeling fine, scheduling an appointment with your doctor for preventive care services is important. Preventive Care Plans & Guidelines. No coverage for oral contraceptive devices. Fewer false alarms reduce unnecessary re-testing along with stress and worry. Easy: Keeping up with your screenings is an important task, even in your busy life. - Ebonie from Chicago, IL [Humana HMO] "I used to have Blue Cross Blue Shield and we didn't have a copay for normal mammograms but even then, I still paid $1700 because the no-cost mammogram lead to ultrasound, another mammogram, and an MRI. 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. should confirm that a prior approval number has been issued. Still, the overall benefit of 2D and 3D breast cancer screening outweigh any potential risks linked to radiation exposure. Since being a carrier is relatively uncommon, doctors usually only test people with a family history of breast or ovarian cancer. If you get benefits from your employer, you may also have these benefits. 2 The HPV vaccine (Gardasil) is covered to age 45 per the Food and Drug Administration (FDA) guidelines. 104 0 obj <> endobj 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. . 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. Your coverage information in the palm of your hand. 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 Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. 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. Your doctor will collect a sample of cells from your cervix to test for any abnormal or precancerous cells. $300 inpatient benefits. Currently, about 12% of women will develop breast cancer at some point in their lifetime. Mammograms are one of the best ways to find it early. Mammogram screening $0 Once per year Nutrition therapy services $0 Ongoing if high risk 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. Women ages 35-39 can receive one baseline mammogram (four views). Yes, they will cover annual mammograms if they are suitable to age. Linked Apps. This screening is no cost to you. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. In contrast, 3D mammograms use CT (computed tomography) scans. 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. 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) . MRI of the breast may be considered medically necessary for individuals with silicone implants whenEITHERof the following are met: MRI of the breast may be considered medically necessary for individuals with no history of known breast cancer, MRI of the breast may be considered medically necessary for individuals with history of known breast cancer. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. . Regular mammograms improve survival rates by 35% in women over 50. 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. 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. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. 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. Mammograms arent as painful as you think you may feel a little pressure but it only lasts a few seconds. Your doctor can help determine your risk level and what steps you should take. Here are some examples: Procedures that may be cosmetic, such as removing scars or excess tissue from your eyes or abdomen; Physical therapy, speech therapy and occupational therapy; Weight-reduction procedures Usage Agreement Provider Manual . SOURCES: Starting June 1, 2022, this follow up colonoscopy will be covered at 100%. Side-to-side and top-to-bottom images . Since their introduction, standard mammograms also called screening mammograms have helped save countless lives. MRI findings should be correlated with clinical history, physical examination results, and the results of mammography and any other prior breast imaging. If physicians have questions about the Blue Cross NC diagnostic imaging management program, they should contact their local Network Management representatives. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Your member ID card is your key to using your medical plan benefits. It may also be used to depict residual disease after neoadjuvant chemotherapy. Cat-scan technology exposes patients to more radiation than an X-rays. See your doctor andrefer to the CDCs posted schedule of immunizations for more information. Blue Cross NC will be the fourth company to implement a diagnostic imaging program in North Carolina. Women ages 40 and older can receive a mammogram (four views) each calendar year. This happens by feeling breast tissue for any lumps or abnormal areas. Use this tool to create personalized recommendations for your . Breast cancer is the most common type of cancer in women. Returning Shopper? According to the American Cancer Society, our state lags behind much of the nation in mammography screenings. Fargo (Headquarters) Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). This can get confusing, so call your health plan before you go. The American Cancer Society recommends women ages 40 to 54 get annual mammograms, and women 55 and older get screenings every two years. How should providers request prior approval? A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. Talking with your healthcare provider about the . 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. Your Florida Blue Medicare health plan includes a mammogram screening every year for women age 40 and over. Fraud and Abuse Hospitals and freestanding imaging centers that perform the imaging services cannot obtain the approval. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Focusing on the right test at the right time for the right patient could save time and mone and increase productivity. Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. Additional Screenings for High-Risk Women What places or settings of treatment are affected? You have coverage from another insurance plan in addition to your Blue Cross and Blue Shield of Nebraska coverage. 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. Your dashboard may experience future loading problems if not resolved. CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval.