blue cross blue shield mammogram coverage

We use cookies on this website to give you the best experience and measure website usage. "Breast cancer is the most common cancer in American women, but men can also develop breast cancer," said Blue Cross and Blue Shield of . During this visit, your doctor examines your overall health. Summary of Arkansas Blue Cross Blue Shield and Health Advantage Coverage Polices. 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. Cost of a Mammogram - 2023 Healthcare Costs - CostHelper Blue Cross NC is very aware of the concerns about self-referral. seen only in single view mammogram without ultrasound correlation); Previous positive breast biopsy within the previous four (4) months and no intervening previous breast MRI; Evaluation of palpable lesion on physical examination and not visualized on ultrasound or mammogram and MRI guided biopsy considered; For evaluation of axillary node metastasis or adenocarcinoma with normal physical examination and normal breast mammogram; Individuals diagnosed with biopsy-proven lobular neoplasia or atypical ductal hyperplasia (ADH); Personal history of or first-degree relative with Le-Fraumeni syndrome (TP53 mutation), Cowden syndrome (PTEN) or Bannayan-RileyRuvalcaba syndrome (BRRS). Coverage Information. Check out the changes and updates to our plan in 2023. The program will apply to members covered by the following plans: Blue Options SM (group PPO plan), Blue Option HRA (group PPO plan), Blue Options HSA (group and individual PPO plan), Classic Blue (Group CMM plan), Dental Blue (group and individual dental plan), Blue Advantage (individual PPO), Short Term Health Care (individual CMM plan). 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. Life-Saving: Cancer detection is the key to early treatment and better outcomes. Will this program impact members' ability to receive the tests they need? No family history, no risk. Your doctor will collect a sample of cells from your cervix to test for any abnormal or precancerous cells. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. 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 Linked Apps. Blue Care Network HMO and POS members. Screening mammograms every 12 months if you are a woman age 40 or older. If there is a medical reason you cannot use a generic statin, your doctor should review this. Preventive Service Benefits - Bcbsal.org Routine gynecological visits. Most Florida Blue plans cover annual screening mammograms for women age 40 and older for as low as a $0 copay. Learn more aboutmammogram screeningsin this video. 2 The HPV vaccine (Gardasil) is covered to age 45 per the Food and Drug Administration (FDA) guidelines. Here's a deeper dive on the potential benefits and risks of a 3D mammogram. Learn more about our non-discrimination policy and no-cost services available to you. Side-to-side and top-to-bottom images . Provider Manual . Log In to the Shopping Cart, Need to Make a Payment? 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. There are significant concerns about patient safety involved in the increased exposure to radiation due to diagnostic imaging procedures. 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. Scenario 1: Brand Truvada, Viread, or Descovy may be made available if you are clinically unable to use generic Truvada. Mammograms are a key component of a womens preventative care. Theyll also look for early signs of breast and cervical cancer. Reimbursement Policy: Screening and Diagnostic Mammography & 3D Tomosynthesis Effective Date: April 15, 2017 Last Reviewed Date: February 14, 2023 Purpose: Provide guidelines for the processing of claims for multiple mammograms, CAD and Digital Breast Tomosynthesis (DBT) to align with recent changes to CMS' position on screening and diagnostic mammograms and to define what a mammographic . Find an in-network doctor for preventive care. Others have a false sense of . You are leaving this website/app ("site"). Forgot Password? However, your group may decide to delay the effective date for coverage until your group's plan . Barium enema is a covered service but not at 100% so you may have out of pocket costs. 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. 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. 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. 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.) 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. Breast cancer is the most widely found cancer in U.S. women, next to skin cancer. These benefits are currently in effect unless otherwise noted. Easy: Keeping up with your screenings is an important task, even in your busy life. 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. This allows the whole breast to be seen. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Mammograms | How to Prevent Breast Cancer | BlueCrossMN So why do so many women put off their mammograms? Limited to a 90 day supply each for two cessation efforts. HMO coverage is offered by Health Options, Inc. DBA Florida Blue HMO. Most breast cancers are found in women 50 years old and older. Starting June 1, 2022, this follow up colonoscopy will be covered at 100%. Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : mammograms. Breast cancer mammography screenings for women over age 40; Colorectal cancer screening for adults over age 45; . Do practicing North Carolina physicians have input into the program? Health Insurance Tax Information; Transparency in Coverage; Mental Health Parity; Teledentistry Services Covered; . Others have a false sense of . listed below will be covered by your plan. Disponible nicamente en ingls. State of South Carolina - Women's Wellness Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. The protection of your privacy will be governed by the privacy policy of that site. "To put it in perspective, the dose of radiation is lower than that of a chest x . Register Now, Ancillary and Specialty Benefits for Employees. Some buy into dangerous myths about breast cancer. By continuing to use this website, you consent to these cookies. 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. They can help detect breast cancer up to three years before it can be felt. All premiums listed represent coverage for dependents up to age 26. These benefits are available for members of non-grandfathered individual health insurance plans. Cancer screenings like colonoscopies and mammograms. What places or settings of treatment are affected? Your doctor may order a colonoscopy more frequently than every 10 years. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services. BATON ROUGE - October is Breast Cancer Awareness Month. 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. By using X-rays, they create two-dimensional images of the breast to spot suspicious tissue that may be cancerous. Mammograms are for older women. What clinical criteria does AIM use to determine if a procedure will be approved? If eligible, you must receive genetic counseling and evaluation services before you receive preventive BRCA testing. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Select Your Gender. Assessing Your Risk 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. Bacteriuria screening for pregnant women. Preventive Care Plans & Guidelines. 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. Examples of these services include: Initial evaluation. File is in portable document format (PDF). Usage Agreement Learn more about our other insurance plans and Medicare plans, or contact a sales . Prior approval is required by all facilities or settings that offer outpatient, nonemergency diagnostic imaging services. Coverage Information | Blue Cross and Blue Shield of Texas Check your Benefit Booklet for details on other preventive care benefits. The remaining 40% are out-of-pocket costs. Fraud and Abuse Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room. Scroll down to see some common services that may or may not be covered during a preventive care visit. Summary of Preventive and Contraceptive Services - CareFirst 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 . Its important for adult women to have annual wellness exams after the age of 21. For more information, view our privacy policy. Make sure to get all the screenings and vaccines recommended for your age and gender. If you have a higher risk for breast cancer, talk to your doctor about screening, no matter how old you are. 18.5 - 24.9: healthy weight. Ho Chi Minh City Hotels | Find & compare great deals on trivago For more information, see the Blue Cross and Blue Shield Service Benefit Plan brochures. $X^ "@\(k'h,@7HI?NH2012|Igl ` |> Find your ideal accommodation from hundreds of great deals and save with www.trivago.com It is important to note that these services are free only when delivered by a doctor or other . Easy: Keeping up with your screenings is an important task, even in your busy life. Screening Saves Lives: Blue Cross Encourages Louisianians to Know If you don't see your insurance plan listed, please contact our Insurance Hotline at 469-398-4099 or email us at [email protected]. Wellness service benefits pay you money*. Annual physical exams and other preventive services are free when you use a Preferred provider. That's No Excuse: It's Time to Get a Mammogram | Blue Cross Blue Shield 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. Linked Apps. The good news is that mammograms can catch cancer early, when its easiest to treat, even if you dont have any symptoms. 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. In fact, we rank 32nd out of 50 states. If you have an HMO or POS plan, there are some additional services you'll need approval for. Forgot Password? A mammogram uses an X-ray to examine the breast tissue and can detect changes before you can feel them. Use this tool to create personalized recommendations for your . Blue Cross and Blue Shield Federal Employee Program Yesterday at 1:00 PM Simple yet warm, this customizable sheet pan lemon-roasted fish . Your coverage may vary from the types of benefits listed below. If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this. Mammogram screening $0 Once per year Nutrition therapy services $0 Ongoing if high risk Description: Screening for cervical cancer. Frequency: May vary based on your health so ask your doctor, Certain breast pumps for pregnant and post-partum women, One manual or electric breast pump purchase per pregnancy is covered, Benefit available during third trimester (starting 11.1.16) or after member has delivered the baby, Breast pumps come with certain supplies, such as tubing, shields and bottles, Breast pumps must be purchased from participating Durable Medical Equipment (DME) vendors. How should providers request prior approval? There are also additional guidelines if you're pregnant. Support Transgender services | Blue Cross Blue Shield of Massachusetts You will be required to pay the plan's physician office copayment or coinsurance. Immunizations for you and your family. Blue Cross and Blue Shield Service Benefit Plan brochures, https://www.mayoclinic.org/tests-procedures/brca-gene-test/about/pac-20384815. 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. Obesity screenings. Breast Cancer. Approve annually starting at age 30; Individuals not yet tested for BRCA gene, but with known BRCA mutation in first degree relative. However, about 72% of women with BRCA1 and about 69% of women with BRCA2 will develop breast cancer by the age of 80. . Breast cancer is the second leading cause of cancer deaths among women in the U.S. Council and Blue Cross and Blue Shield of . BRCA is an abbreviation for the BReast CAncer gene, which is an inherited trait. Your doctor can help determine your risk level and what steps you should take. 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. This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs. 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? As always, be sure to check your specific plan coverage and see an in-network provider. Mammograms 101 - Anthem Most PDF readers are a free download. http://www.breastcancer.org/symptoms/understand_bc/statistics Healthy tissue may appear suspicious and cancerous tissue can be masked. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. Women ages 40 and older can receive a mammogram (four views) each calendar year. 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%. January 25, 2016. hrHPV test only every 5 years. Health Focus: Breast Cancer Prevention | Blue Cross Blue Shield of Alabama Screening for depression in postpartum women. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. Help Center. $300 inpatient benefits. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. 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. Preventive Care for Women | Blue Cross NC Inscribirse ahora! It may also be used to depict residual disease after neoadjuvant chemotherapy. Depression screenings. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. You usually need to get tested every 3 to 5 years. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. 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. 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. 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 transgendered individuals, you have access to medically appropriate preventive services. A follow-up study may be considered medically necessary to help evaluate an individual's progress after treatment, procedure, intervention or surgery. The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue Shield of Alabama. Coverage - a BCBSMA news service - Blue Cross Blue Shield MA MediaRoom 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. 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 It's important for adult women to have annual wellness exams after the age of 21. 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) .

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