blue cross blue shield mammogram coverage

Dental, Life and Disability are offered by Florida Combined Life . Blue Shield of California 1999 . Fargo (Headquarters) Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Provider Manual . Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. http://www.breastcancer.org/symptoms/understand_bc/statistics File is in portable document format (PDF). Who Should Get It: Women age 21 - 65. 25 - 29.9: overweight. 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. When it's diagnostic: If your doctor . When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. In fact, we rank 32nd out of 50 states. This Bronze standard plan premium covers 60% of costs. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. You should call the number on the back of your member ID card for more information before you schedule one. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. Breast Cancer. 2 The HPV vaccine (Gardasil) is covered to age 45 per the Food and Drug Administration (FDA) guidelines. You have coverage from another insurance plan in addition to your Blue Cross and Blue Shield of Nebraska coverage. HMO coverage is offered by Health Options, Inc. DBA Florida Blue HMO. Providers can find complete instructions on how to request prior approval outlined on the diagnostic imaging procedures page. Standard 2D mammograms take two pictures of the breast. BATON ROUGE - October is Breast Cancer Awareness Month. 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. It happens in both men and women, but breast cancer in men is not common. Do practicing North Carolina physicians have input into the program? Which health plans does the program apply to? . No lump, no cancer. No family history, no risk. Take advantage of preventive care and stop problems before they get serious. 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. Standard 2D mammograms take two pictures of the breast. 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. Mental Health Services. January 25, 2016. The age and frequency listed below are general recommendations. Technical Information Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. Most PDF readers are a free download. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. Routine gynecological visits. Blue Cross NC data confirm there is significant opportunity to contain health care costs and reduce member exposure to radiation by eliminating scans that are clinically inappropriate or noncontributory to the care. Mammograms are for older women. BCBSIL Provider Manual June 2020 2 . Usage Agreement Health plans are offered by Blue Shield of California. This allows the whole breast to be seen. 104 0 obj <> endobj Your browser is not supported. 3D mammograms may be covered by your health plan. In contrast, 3D mammograms use CT (computed tomography) scans. 18.5 - 24.9: healthy weight. Side-to-side and top-to-bottom images . They can help detect breast cancer up to three years before it can be felt. Hysterectomies are not performed solely for sterilization so are not covered as preventive. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . Some women have a higher risk of developing cancer than other women. Mammograms are for older women. Easy: Keeping up with your screenings is an important task, even in your busy life. If so, it should not impact the ability of members to receive these tests. Cat-scan technology exposes patients to more radiation than an X-rays. Non-Discrimination Statement and Foreign language Access. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Annually about 220,000 women are diagnosed with breast cancer. No. Assessing Your Risk Accessibility Routine health checkups. Scroll down to see some common services that may or may not be covered during a preventive care visit. 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. They are regularly reviewed by physicians of appropriate specialties for consistency with the most recent medical evidence. Enroll Now. Additional mammograms may require cost sharing. Mammogram screening $0 Once per year Nutrition therapy services $0 Ongoing if high risk If physicians have questions about the Blue Cross NC diagnostic imaging management program, they should contact their local Network Management representatives. Blue Care Network HMO and POS members. Find out what preventive care services are appropriate for you and build a list to share with your doctor. You must also receive prior approval from us. How do 3D Mammograms Differ From Standard Ones? Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. 4510 13th Ave. S. "Breast cancer is the most common cancer in American women, but men can also develop breast cancer," said Blue Cross and Blue Shield of . Did you know that one in eight women will develop invasive breast cancer at some point in her life? Best Answer. Psychotherapy. A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. 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%. 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. Am I eligible for these benefits at 100%? - 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. Some preventive care services require that you meet . Here's a deeper dive on the potential benefits and risks of a 3D mammogram. BSC6.07 Digital Breast Tomosynthesis. How should providers request prior approval? One of the goals of this program is to help contain health care costs. What clinical criteria does AIM use to determine if a procedure will be approved? Your member ID card is your key to using your medical plan benefits. The goal of the diagnostic imaging program is to improve affordability of health care to Blue Cross NC members. Women who get a 3D mammogram may also get a traditional 2D mammogram, exposing them to higher amounts of radiation. For example, women who have a family history of breast, cervical or ovarian cancer can be tested for the BRCA1 or BRCA2 genes. Breast cancer is the second leading cause of cancer deaths among women in the U.S. The U.S. Preventive Services Task Force currently recognizes both 2D and 3D mammography as equally acceptable screening methods. The average mammogram appointment is just 15 minutes long. Limited to a 90 day supply each for two cessation efforts. 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. 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. Approve annually starting at age 30; Individuals not yet tested for BRCA gene, but with known BRCA mutation in first degree relative. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. The site may also contain non-Medicare related information. During this visit, your doctor examines your overall health. BlueCross BlueShield of South Carolina. 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? NRT through the pharmacy benefit is available only with a prescription. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. Blue Cross and Blue Shield Federal Employee Program Yesterday at 1:00 PM Simple yet warm, this customizable sheet pan lemon-roasted fish . What imaging procedures do NOT require prior approval? Learn the facts, and then schedule an appointment today! 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.) Still, the overall benefit of 2D and 3D breast cancer screening outweigh any potential risks linked to radiation exposure. When it's preventive: You get a mammogram to check for breast cancer. Scenario 2: Your claim for emtricitabine/tenofovir (generic Truvada) or Apretude is not paying at 100% and you are using it for PrEP. (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. About 10% of patients who receive routine mammograms get called back for another look. 1 If you have gotten one dose of Zostavax vaccine for shingles, you should also get the two doses of Shingrix vaccine. 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). If there is a medical reason you cannot use a generic statin, your doctor should review this. 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. Coverage is subject to the specific terms of the member's benefit plan. Learn more about our non-discrimination policy and no-cost services available to you. During your visit, your doctor will perform a clinical breast exam. 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. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services. How long is an authorization of a diagnostic imaging procedure valid? Blue Cross and Blue Shield Association. Inscribirse ahora! Mammograms are one of the best ways to find it early. The issue of return on investment and appropriateness of guidelines will be continually addressed as part of the evaluation of the program. For this reason, 2D mammograms can sometimes produce inaccurate findings.