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. They'll also look for early signs of breast and cervical cancer. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Access Your Payment Options. BSC6.07 Digital Breast Tomosynthesis - Blue Shield of California 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. Tissue doesnt overlap. As an example, women get regular mammograms at no cost to them as a preventive screening. To view this file, you may need to install a PDF reader program. Know the Difference Between a Preventive and Diagnostic - Florida Blue We recommend receiving estimates close to . Blue Cross Blue Shield of Massachusetts - Healthy Times - Preventive Heres a deeper dive on the potential benefits and risks of a 3D mammogram. Since being a carrier is relatively uncommon, doctors usually only test people with a family history of breast or ovarian cancer. Provider consultation prior to the colonoscopy procedure is covered at 100%. Still, over the past decade, there have been advances in mammogram technology. 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. A mammogram uses an X-ray to examine the breast tissue and can detect changes before you can feel them. Is the program focused mainly on saving money? Scenario 1: Brand Truvada, Viread, or Descovy may be made available if you are clinically unable to use generic Truvada. All women need to be informed by their healthcare provider about the best screening options for them. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Regence supports women's preventive breast health | Regence Routine gynecological visits. Most breast cancers are found in women 50 years old and older. Your Guide to Women's Preventive Care - FEP Blue Most basis mammogram screenings are covered by your health plan. While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram. 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. HMO Scope of Benefits Section . 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). 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 . If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this. Your Florida Blue Medicare health plan includes a mammogram screening every year for women age 40 and over. Necesita su ID de usuario? January 25, 2016. Disponible nicamente en ingls. 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. How do 3D Mammograms Differ From Standard Ones? BCBSIL Provider Manual June 2020 2 . All premiums listed represent coverage for dependents up to age 26. Most PDF readers are a free download. One its drawbacks is breast tissue can overlap during compression. Frequently Asked Questions: Mammograms - Blue Cross Blue Shield of One option is Adobe Reader which has a built-in reader. SOURCES: recipe is no mess, no fuss and all flavor. Non-Discrimination Statement and Foreign language Access. MRI findings should be correlated with clinical history, physical examination results, and the results of mammography and any other prior breast imaging. Cost estimates are based only on the coverage you have with us. Mammograms are one of the best ways to find it early. "To put it in perspective, the dose of radiation is lower than that of a chest x . Standard 2D mammograms take two pictures of the breast. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. 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. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. What are the goals of the diagnostic imaging management program? No coverage for routine physical examinations. By continuing to use this website, you consent to these cookies. Texas insurers to cover advanced breast cancer screenings Learn more about our non-discrimination policy and no-cost services available to you. A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. What places or settings of treatment are affected? Some providers charge more, and some offer an uninsured discount. Annually about 220,000 women are diagnosed with breast cancer. BlueCross BlueShield of South Carolina. Use this tool to create personalized recommendations for your . Data shows that roughly 30-40% of imaging exams are considered clinically inappropriate or noncontributory. Site Map 18.5 - 24.9: healthy weight. Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : mammograms. Will this program impact members' ability to receive the tests they need? Register Now, Ancillary and Specialty Benefits for Employees. Ordering physicians for Blue Cross NC members must obtain prior approval prior to scheduling an imaging exam for outpatient diagnostic, non-emergent services. If you have a positive fecal blood test (gFOBT or FIT or Cologuard) or visualization test (CT colonography or sigmoidoscopy), your doctor may order a follow up colonoscopy. Women ages 35-39 can receive one baseline mammogram(four views). 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 Bronze standard plan premium covers 60% of costs. Counseling. Some preventive care services require that you meet . Breast cancer is the second leading cause of cancer deaths among women in the U.S. 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. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. 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.) No coverage for oral contraceptive devices. 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 The protection of your privacy will be governed by the privacy policy of that site. The policies were effective September 1, 2010 for Blue Medicare HMO and Blue Medicare PPO plans. Screening and Diagnostic Mammography & 3D Tomosynthesis - Horizon Blue No one wants the dreaded callback after a mammogram. Under a new *Applicable Wellness Screenings: $50 benefit paid one time per year, per insured (age 18 and over) for breast ultrasound, breast MRI, mammograms, CA 15-3 . Healthy tissue may appear suspicious and cancerous tissue can be masked. Tobacco and alcohol use evaluations. We can send you an email with information on our health care plans. 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. Cancer and Hospital Insurance | Blue Cross and Blue Shield of Kansas Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Blue Cross and Blue Shield Service Benefit Plan brochures, https://www.mayoclinic.org/tests-procedures/brca-gene-test/about/pac-20384815. Negotiated rates with providers can change, therefore, changing the estimate. $300 inpatient benefits. Preventive Service Benefits - Bcbsal.org 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). Connect Community - Blue Cross and Blue Shield of Illinois, Radiation treatments to the breast or chest area. Who reviews requests for diagnostic imaging prior approval? The program does not currently apply to FEP, Medicare Supplemental or Medicare Prescription Drug Plans. Compare the prices of 26634 hotels in Ho Chi Minh City, Vietnam. Mammograms 101 - Anthem . You are only exposed to a small amount of radiation during a mammogram, and studies show that the benefits of mammograms outweigh any risks. Regence supports women's preventive breast health. Who can physicians call if they have questions? Breast cancer is the most common type of cancer in women. Screening for Breast Cancer 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. 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. Depression screenings. They can help detect breast cancer up to three years before it can be felt. Issuance of a prior approval number is not a guarantee of payment. 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. 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. This new site may be offered by a vendor or an independent third party. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the . What process is in place for unfavorable determinations? Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Breast Cancer. 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. Separately billed services are not covered under preventive services and are subject to the normal benefits based on place of service, may have them as a covered benefit, but not as a preventive care benefit covered at 100%, may not have contraceptive benefits through your group medical plan, If either of these two scenarios apply to you, have your provider fill out and fax. Health Focus: Breast Cancer Prevention | Blue Cross Blue Shield of Alabama 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. 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 . 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. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Side-to-side and top-to-bottom images are made. 30 and above: obese. Privacy Policy Did you know preventive health measures and screenings can prevent 85% of illness and disease, and are covered at no cost for many plans? The diagnostic imaging management program impact is low; why did Blue Cross NC implement it? For example, at the Kapiolani Medical Center [ 1] in Aiea, Hawaii, where the full . Technical Information Forgot User ID? 2021 plans will be available for purchase beginning on November 1, 2020. Take advantage of preventive care and stop problems before they get serious. Domestic Travel When traveling outside of Vermont you may need access to medical services. Hysterectomies are not performed solely for sterilization so are not covered as preventive. Your doctor will advise on recommended immunizations that can protect against a number of serious diseases. 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. Breast cancer is the most widely found cancer in U.S. women, next to skin cancer. Approve annually starting at age 30; Individuals with known BRCA mutation. Please check your coverage with your insurance provider before your appointment with us. to expand insurance coverage for diagnostic mammograms. Pays cash if you're treated for cancer. 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. Forgot Password? Please enter a valid date of birth (MM/DD/YYYY), 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, PDF File is in portable document format (PDF). Additionally, we cover computer-assisted detection for those women who seek an extra level of screening for breast cancer. Breast cancer risk factors include: Check with your doctor if you have questions about mammograms or other breast cancer screenings. For more information, see the Blue Cross and Blue Shield Service Benefit Plan brochures. For transgendered individuals, you have access to medically appropriate preventive services. Women ages 40 and older can receive a mammogram (four views) each calendar year. The scans take detailed X-ray images from many angles. Coverage Policy Manual - Arkansas Blue Cross and Blue Shield Out of network billing can lead to unexpected charges. Routine mammograms are covered by the state health plan at no cost to you. What clinical criteria does AIM use to determine if a procedure will be approved? Plus, your medical plan covers 100% of the costs for preventive health services when care is provided through network providers. Insurance. Wellness service benefits pay you money*. TheU.S. Preventive Services Task Forcerecommends that women between the ages of 50 and 74 get a mammogram every two years. Routine health checkups. - 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. Has Blue Cross NC considered disallowing self-referrals? Heres everything you need to know about it. Hospitals and freestanding imaging centers that perform the imaging services cannot obtain the approval. Not all participating DME vendors carry breast pumps. NRT through QuitlineNC is available without a prescription. In contrast, 3D mammograms use CT (computed tomography) scans. 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. 2023 Blue Cross and Blue Shield of North Carolina. Theyll also look for early signs of breast and cervical cancer. Check out the changes and updates to our plan in 2023. You should get screenings every one or two years, depending on your doctor's advice. File is in portable document format (PDF). Members must enroll in the multi-call program to qualify for up to 12 weeks of NRT. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Does Blue Cross Blue Shield cover annual mammograms? - Answers 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Mammograms use very small doses of radiation and the risk of harm is very low. Usage Agreement Our goal is to review diagnostic imaging tests to determine if each test is clinically appropriate for the specific situation. Women ages 35-39 can receive one baseline mammogram (four views). BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Does this prior approval impact Blue Medicare HMO and Blue Medicare PPO? About one in every seven or eight women gets it in her lifetime. Call us at 1-888-243-4420 if you have questions or need help. Health plans are offered by Blue Shield of California. 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. For more information, view our privacy policy. Please review the terms of use and privacy policies of the new site you will be visiting. Annual physical exams and other preventive services are free when you use a Preferred provider. Heres everything you need to know about it. Blue Cross and Blue Shield Federal Employee Program . "Breast cancer is the most common cancer in American women, but men can also develop breast cancer," said Blue Cross and Blue Shield of . Returning Shopper? Mammography is highly regulated by the Food and Drug Administration, the Mammography Quality and Standards Act and other governing organizations like the American College of Radiology. You should call the number on the back of your member ID card for more information before you schedule one. Coverage that is supplemental to Medicare but with no member cost Life-Saving: Cancer detection is the key to early treatment and better outcomes. Some state or federal mandates [e.g., Federal Employee Program (FEP)] prohibits plans from Learn more aboutmammogram screeningsin this video. Inscribirse ahora! Fraud and Abuse All rights reserved. What information is required to request prior approval? The good news is that mammograms can catch cancer early, when its easiest to treat, even if you dont have any symptoms. Talk to your doctor to find out which of these you should have based on your health. The issue of return on investment and appropriateness of guidelines will be continually addressed as part of the evaluation of the program. Register Now, Ancillary and Specialty Benefits for Employees. Ordering physicians may also contact the AIM physician reviewer at any time during the authorization process. Provider Manual . You are leaving this website/app ("site"). 104 0 obj <> endobj This can get confusing, so call your health plan before you go. Privacy Policy The policies were effective for diagnostic imaging services performed on or after February 15, 2007 for Blue Cross NC commercial plans. 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. Copy. 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. Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years.

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