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). "To put it in perspective, the dose of radiation is lower than that of a chest x-ray," Mehta said. Breast cancer is the second leading cause of cancer deaths among women in the U.S. Who can physicians call if they have questions? Side-to-side and top-to-bottom images . Enroll Now. 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. To be covered with no out-of-pocket costs, the service must be: Special information for employees of religious organizations. Focusing on the right test at the right time for the right patient could save time and mone and increase productivity. Check out the changes and updates to our plan in 2023. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Thanks in part to preventive screenings, there are approximately 2.8 million breast cancer survivors in the U.S. as of 2016. Additionally, we cover computer-assisted detection for those women who seek an extra level of screening for breast cancer. A high BMI can be a warning sign for potential health problems. Regence supports women's preventive breast health. listed below will be covered by your plan. Blue Shield of California is an independent member of the Blue Shield Association. This happens by feeling breast tissue for any lumps or abnormal areas. Life-Saving: Cancer detection is the key to early treatment and better outcomes. Combined together, the X-rays create a three-dimensional picture of each breast. Find out what preventive care services are appropriate for you and build a list to share with your doctor. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Screenings, tests and other preventive care services Preventive care service Cost . The remaining 40% are out-of-pocket costs. Your member ID card is your key to using your medical plan benefits. 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. You must also receive prior approval from us. As North Dakotans, we can do better in checking for breast cancer. Bacteriuria screening for pregnant women. Mental Health Services. $300 inpatient benefits. January 25, 2016. 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. Cost estimates are based only on the coverage you have with us. Your browser is not supported. Echocardiography studies (effective for both Commercial and Blue Medicare HMO\PPO lines of business as of January 2, 2014), Member identification number, name, date of birth, and health plan, Imaging exam(s) being requested (body part, right, left or bilateral), Patient diagnosis (suspected or confirmed), Clinical symptoms/indications (intensity/duration), Results of treatment history (previous tests, duration of previous therapy, relevant clinical medical history), American Institute of Ultrasound in Medicine (AIUM), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare & Medicaid Services (CMS) Local Coverage Determinations (LCD) and National Coverage Determinations (NCD), Promoting and guiding the selection of the most appropriate and cost-effective diagnostic imaging services, Encouraging standardization of medical practice patterns and reducing variation in clinical evaluation, Curtailing the performance of inappropriate diagnostic imaging studies, Advocating biosafety issues, including reduction of clinical radiation exposure (for CT and plain film radiography), Enhancing quality of health care for diagnostic imaging studies using evidence-based medicine and outcomes research from numerous resources. By using X-rays, they create two-dimensional images of the breast to spot suspicious tissue that may be cancerous. mammogram for women between ages 35-39. You have coverage from another insurance plan in addition to your Blue Cross and Blue Shield of Nebraska coverage. What process is in place for unfavorable determinations? No family history, no risk. For more information, see the Blue Cross and Blue Shield Service Benefit Plan brochures. Examples of these services include: Initial evaluation. CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval. If your Summary of Benefits section of your Benefit Booklet contains PREVENTIVE CARE covered under federal law, then you have these benefits at no charge IN-NETWORK. Most breast cancers are found in women 50 years old and older. 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 are leaving this website/app ("site"). hbbd``b` Find A Doctor Or Hospital In Your Network. 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. Log In to the Shopping Cart, Need to Make a Payment? If physicians have questions about the Blue Cross NC diagnostic imaging management program, they should contact their local Network Management representatives. Fortunately, only about 1 in 400 people have a BRCA gene. Please review the terms of use and privacy policies of the new site you will be visiting. By continuing to use this website, you consent to these cookies. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Your coverage may vary from the types of benefits listed below. %%EOF
Disponible nicamente en ingls. Your doctor may order a colonoscopy more frequently than every 10 years. Most breast cancers are found in women 50 years old and older. One of the goals of this program is to help contain health care costs. However, about 72% of women with BRCA1 and about 69% of women with BRCA2 will develop breast cancer by the age of 80. Mammogram screening $0 Once per year Nutrition therapy services $0 Ongoing if high risk It's important for adult women to have annual wellness exams after the age of 21. While 3D mammograms show some promise in better health outcomes, there isnt enough research to advocate them over 2D mammograms. You will be required to pay the plan's physician office copayment or coinsurance. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. All rights reserved. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. Check out the changes and updates to our plan in 2023. Side-to-side and top-to-bottom images are made. For screening examination to detect breast cancer in. Screening can help find breast cancer early, when it is easier to treat. By Regence. Women ages 35-39 can receive one baseline mammogram (four views). BATON ROUGE - October is Breast Cancer Awareness Month. This can get confusing, so call your health plan before you go. Preventive Care Plans & Guidelines. Provider consultation prior to the colonoscopy procedure is covered at 100%. Obesity screenings. 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. 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? They are regularly reviewed by physicians of appropriate specialties for consistency with the most recent medical evidence. Does this prior approval impact Blue Medicare HMO and Blue Medicare PPO? Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. This is very important in clinical decision making as alternative therapies may be selected based upon the results obtained from the MRI. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. Best Answer. 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. Connect Community - Blue Cross and Blue Shield of Illinois, Radiation treatments to the breast or chest area. Learn more about our non-discrimination policy and no-cost services available to you. The good news is that mammograms can catch cancer early, when its easiest to treat, even if you dont have any symptoms. Evaluation of suspected breast cancer when other imaging examinations, such as ultrasound and mammography, and physical examination are inconclusive for the presence of breast cancer, and biopsy could not be performed (e.g. Blue Cross NC has partnered with American Imaging Management, Inc. (AIM) for the management of outpatient, high-tech diagnostic imaging services. Screening for depression in postpartum women. 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. Did you know that one in eight women will develop invasive breast cancer at some point in her life? Forgot User ID? Heres everything you need to know about it. They can help detect breast cancer up to three years before it can be felt. Provided by an in-network doctor or facility (urgent care facility, outpatient clinic or ambulatory surgery center), Filed by your doctor as a preventive care visit, Identified as preventive care under the Affordable Care Act (ACA), In women age 2129 with cervial cytology (pap test) every 3 years, A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. Necesita su ID de usuario? Additional Screenings for High-Risk Women
The American Cancer Society recommends women ages 40 to 54 get annual mammograms, and women 55 and older get screenings every two years. 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 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. 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. Some providers charge more, and some offer an uninsured discount. Breast cancer is the most common type of cancer in women. This is especially important for women who have dense breast tissue. Olvido su contrasea? While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram. 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. Description: Screening for cervical cancer. Still, the overall benefit of 2D and 3D breast cancer screening outweigh any potential risks linked to radiation exposure. Did you know preventive health measures and screenings can prevent 85% of illness and disease, and are covered at no cost for many plans? 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. 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. During this visit, your doctor examines your overall health. 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. Negotiated rates with providers can change, therefore, changing the estimate. The policies were effective for diagnostic imaging services performed on or after February 15, 2007 for Blue Cross NC commercial plans. . Limited to a 90 day supply each for two cessation efforts. 122 0 obj
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Women who get a 3D mammogram may also get a traditional 2D mammogram, exposing them to higher amounts of radiation. Plus, your medical plan covers 100% of the costs for preventive health services when care is provided through network providers. Breast tomosynthesis is an . The site may also contain non-Medicare related information. Here's how to interpret your BMI: Below 18.5: underweight. It happens in both men and women, but breast cancer in men is not common. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the . . Some state or federal mandates [e.g., Federal Employee Program (FEP)] prohibits plans from Easy: Keeping up with your screenings is an important task, even in your busy life. Please send us your question so a licensed agent can contact you. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Usage Agreement Call us at 1-888-243-4420 if you have questions or need help. Most PDF readers are a free download. What imaging procedures do NOT require prior approval? The goal of the diagnostic imaging program is to improve affordability of health care to Blue Cross NC members. File is in portable document format (PDF). Access Your Payment Options. After your annual preventive exam, you will receive an Explanation of Benefits (EOB) from Blue Shield of California to notify you that your claim has been processed. To view this file, you may need to install a PDF reader program. Check your Benefit Booklet for details on other preventive care benefits. Who reviews requests for diagnostic imaging prior approval? Your dashboard may experience future loading problems if not resolved. Routine mammograms are covered by the state health plan at no cost to you. Technical Information Insurance. Scroll down to see some common services that may or may not be covered during a preventive care visit. Some buy into dangerous myths about breast cancer. Blue Shield of California 1999 . Breast Cancer and Early Detection: What Women Need to Know. 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. Usage Agreement We apologize for any inconvenience. Please review the terms of use and privacy policies of the new site you will be visiting. The program does not currently apply to FEP, Medicare Supplemental or Medicare Prescription Drug Plans. In contrast, 3D mammograms use CT (computed tomography) scans. Your doctor will help you decide what schedule makes the most sense for you. Forgot Password? Your Florida Blue Medicare health plan includes a mammogram screening every year for women age 40 and over. Routine physical exams where your doctor reviews the following: This exam is prevention focused, not problem focused. Approve annually starting at age 30; Individuals with known BRCA mutation. This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs. 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 of Illinois . 2021 plans will be available for purchase beginning on November 1, 2020. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. These benefits are currently in effect unless otherwise noted. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. 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). https://www.anthem.com/health-insurance/health-care-reform-resources/reform-law-detail/more-womens-preventive-care-covered?reformlaw=l1019
Women ages 35-39 can receive one baseline mammogram(four views). The site may also contain non-Medicare related information. Reproduction without authorization from Blue Shield of California is prohibited. 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.