Here's a deeper dive on the potential benefits and risks of a 3D mammogram. 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. Blue Care Network HMO and POS members. Find an in-network doctor for preventive care. 25 - 29.9: overweight. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. We apologize for any inconvenience. Will this program impact members' ability to receive the tests they need? Download the BCBSIL App. For more information, see the Blue Cross and Blue Shield Service Benefit Plan brochures. Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. Its important for adult women to have annual wellness exams after the age of 21. "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. Understand the difference between preventive and diagnostic. Pays in addition to your other coverages. What clinical criteria does AIM use to determine if a procedure will be approved? Usage Agreement 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. It happens in both men and women, but breast cancer in men is not common. Standard 2D mammograms take two pictures of the breast. Your doctor can help you choose a facility thats convenient for you. List of all medications that are covered at 100% onall formularies. 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? Domestic Travel When traveling outside of Vermont you may need access to medical services. $X^ "@\(k'h,@7HI?NH2012|Igl ` |> Issuance of a prior approval number is not a guarantee of payment. 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. Limited to a 90 day supply each for two cessation efforts. Has Blue Cross NC considered disallowing self-referrals? Easy: Keeping up with your screenings is an important task, even in your busy life. 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 browser is not supported. Focusing on the right test at the right time for the right patient could save time and mone and increase productivity. Anemia screening for pregnant women. Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. One its drawbacks is breast tissue can overlap during compression. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. Your doctor may order a colonoscopy more frequently than every 10 years. If so, it should not impact the ability of members to receive these tests. %%EOF The site may also contain non-Medicare related information. Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested. Combined together, the X-rays create a three-dimensional picture of each breast. Learn more aboutmammogram screeningsin this video. Are you going to reimburse providers for the savings Blue Cross NC will incur? Your doctor can help determine your risk level and what steps you should take. It may also be used to depict residual disease after neoadjuvant chemotherapy. Here's how to interpret your BMI: Below 18.5: underweight. Of the 4 million women age 40 to 65 in Texas, 2.6 million . 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. Ordering physicians for Blue Cross NC members must obtain prior approval prior to scheduling an imaging exam for outpatient diagnostic, non-emergent services. Your coverage information in the palm of your hand. Site Map No coverage for routine physical examinations. Starting June 1, 2022, this follow up colonoscopy will be covered at 100%. What imaging procedures do NOT require prior approval? We have an obligation to our members to provide quality care at an affordable price. This is especially important for women who have dense breast tissue. BRCA is an abbreviation for the BReast CAncer gene, which is an inherited trait. For transgendered individuals, you have access to medically appropriate preventive services. Fraud and Abuse Learn more about our non-discrimination policy and no-cost services available to you. 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 . Your Florida Blue Medicare health plan includes a mammogram screening every year for women age 40 and over. In addition, some sites may require you to agree to their terms of use and privacy policy. Learn the facts, and then schedule an appointment today! Breast tomosynthesis is an . 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. 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. January 25, 2016. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . While 3D mammograms show some promise in better health outcomes, there isnt enough research to advocate them over 2D mammograms. Blue Cross NC will be the fourth company to implement a diagnostic imaging program in North Carolina. Your doctor will collect a sample of cells from your cervix to test for any abnormal or precancerous cells. The American Cancer Society recommends women ages 40 to 54 get annual mammograms, and women 55 and older get screenings every two years. Check out the changes and updates to our plan in 2023. Your coverage may vary from the types of benefits listed below. For that reason, benefits for preventive BRCA testing are available for members with a family history of certain cancers. Scenario 1: Brand Truvada, Viread, or Descovy may be made available if you are clinically unable to use generic Truvada. Women between the ages of 40 and 49 should talk to their doctor about when they should start getting mammograms. Fewer false alarms reduce unnecessary re-testing along with stress and worry. Theyll also look for early signs of breast and cervical cancer. This happens by feeling breast tissue for any lumps or abnormal areas. SOURCES: Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Tissue doesnt overlap. Who can physicians call if they have questions? When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. This allows the whole breast to be seen. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. You can also visit our Mental Health Resource . Description: Screening for cervical cancer. Generally, practicing consistently with national evidence-based guidelines is expected to reduce errors and liability. Blue Cross NC has partnered with American Imaging Management, Inc. (AIM) for the management of outpatient, high-tech diagnostic imaging services. Olvido su contrasea? 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). It's important for adult women to have annual wellness exams after the age of 21. It is important to note that these services are free only when delivered by a doctor or other . BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. The scans take detailed X-ray images from many angles. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. Pays cash if you're treated for cancer. 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. Some state or federal mandates [e.g., Federal Employee Program (FEP)] prohibits plans from While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram. Returning Shopper? Additionally, we cover computer-assisted detection for those women who seek an extra level of screening for breast cancer. For this reason, 2D mammograms can sometimes produce inaccurate findings. Currently, about 12% of women will develop breast cancer at some point in their lifetime. The cost of many screenings and checkups is covered at 100% with no out of pocket costs for you and those on your plan. Dental, Life and Disability are offered by Florida Combined Life . Talking with your healthcare provider about the . They are regularly reviewed by physicians of appropriate specialties for consistency with the most recent medical evidence. However, some services like 3D imaging or ultrasounds may not be fully covered the same way. If you have a higher risk for breast cancer, talk to your doctor about screening, no matter how old you are. However, sometimes tests are ordered and are not clinically appropriate. Did you know that one in eight women will develop invasive breast cancer at some point in her life? Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. "To put it in perspective, the dose of radiation is lower than that of a chest x . For example, women who have a family history of breast, cervical or ovarian cancer can be tested for the BRCA1 or BRCA2 genes. It often forms in the tubes that carry milk to the nipple (ducts) and in glands that make milk (lobules). As always, be sure to check your specific plan coverage and see an in-network provider. The policies were effective September 1, 2010 for Blue Medicare HMO and Blue Medicare PPO plans. Cancer screenings like colonoscopies and mammograms. Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. Its common to receive a Pap test (also called a Pap smear or pelvic exam) during your visit. 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. The goal of the diagnostic imaging program is to improve affordability of health care to Blue Cross NC members. This Bronze standard plan premium covers 60% of costs. BATON ROUGE - October is Breast Cancer Awareness Month. The policies were effective for diagnostic imaging services performed on or after February 15, 2007 for Blue Cross NC commercial plans. During your visit, your doctor will determine what tests or health screenings are right for you based on factors such as your age, gender, health status, and health and family history. 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. This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Scroll down to see some common services that may or may not be covered during a preventive care visit. You usually need to get tested every 3 to 5 years. Ordering physicians may also contact the AIM physician reviewer at any time during the authorization process. mammogram for women between ages 35-39. These benefits are currently in effect unless otherwise noted. Others have a false sense of . 2005 - 2022 copyright of Anthem Insurance Companies, Inc. To capture them, the breast is pulled away from the body, compressed and held between two glass plates.
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