Connect Community - Blue Cross and Blue Shield of Illinois, Radiation treatments to the breast or chest area. Additionally, the increased use of some high technology imaging procedures creates patient safety concerns from radiation exposure. Another Reason to Get Moving: Exercise Can Help Lower Cancer Risk. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. 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. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Forgot User ID? All women 40 or older should ask their doctor about when to start getting mammograms and how often theyre needed. Privacy Policy Learn more about our other insurance plans and Medicare plans, or contact a sales . Ordering physicians may also contact the AIM physician reviewer at any time during the authorization process. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. This is especially important for women who have dense breast tissue. All premiums listed represent coverage for dependents up to age 26. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. However, about 72% of women with BRCA1 and about 69% of women with BRCA2 will develop breast cancer by the age of 80. mammogram for women between ages 35-39. To be covered with no out-of-pocket costs, the service must be: Special information for employees of religious organizations. Hospitals and freestanding imaging centers that perform the imaging services cannot obtain the approval. Pays in addition to your other coverages. Approve annually starting at age 30; Individuals with known BRCA mutation. 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.) Counseling. We can send you an email with information on our health care plans. Standard 2D mammograms take two pictures of the breast. Diagnostic mammograms more frequently than once a year, if medically necessary. 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. Routine gynecological visits. 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 should confirm that a prior approval number has been issued. By Regence. Many travel vaccines are not covered including: Your doctor will determine what tests or health screenings are needed based on your age, gender, and overall health status. So why do so many women put off their mammograms? To view this file, you may need to install a PDF reader program. Screening for depression in postpartum women. Regular mammograms improve survival rates by, Thanks in part to preventive screenings, there are approximately, The average mammogram appointment is just. The age and frequency listed below are general recommendations. 2 The HPV vaccine (Gardasil) is covered to age 45 per the Food and Drug Administration (FDA) guidelines. For more information, view our privacy policy. During this visit, your doctor examines your overall health. "To put it in perspective, the dose of radiation is lower than that of a chest x . Depression screenings. Still, over the past decade, there have been advances in mammogram technology. The program does not currently apply to FEP, Medicare Supplemental or Medicare Prescription Drug Plans. Standard 2D mammograms take two pictures of the breast. "When a provider recommends getting screened, it indicates the risks outweigh the benefit and it is deemed to be safe," Dallow said, adding that under the . 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. There are also additional guidelines if you're pregnant. This allows the whole breast to be seen. Negotiated rates with providers can change, therefore, changing the estimate. recipe is no mess, no fuss and all flavor. Servicing providers (hospitals, freestanding imaging centers, etc.) - 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. While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram. 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. Please check your coverage with your insurance provider before your appointment with us. "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. Psychotherapy. Approve annually starting at age 30; Individuals not yet tested for BRCA gene, but with known BRCA mutation in first degree relative. Find your ideal accommodation from hundreds of great deals and save with Blue Cross NC has partnered with American Imaging Management, Inc. (AIM) for the management of outpatient, high-tech diagnostic imaging services. Forgot Password? Provider consultation prior to the colonoscopy procedure is covered at 100%. You must also receive prior approval from us. Examples of these services include: Initial evaluation. No prescription medication or NRT limit when received via pharmacy benefit, Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap). For most women, mammogram technology is still considered the best way to detect breast abnormalities and cancers early. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. Most Florida Blue plans cover annual screening mammograms for women age 40 and older for as low as a $0 copay. You are viewing estimated values for an individual. Blue Cross and Blue Shield Service Benefit Plan brochures, Prior approval is required by all facilities or settings that offer outpatient, nonemergency diagnostic imaging services. 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. During this visit, your doctor examines your overall health. List of all medications that are covered at 100% onall formularies. Thanks in part to preventive screenings, there are approximately 2.8 million breast cancer survivors in the U.S. as of 2016. Please send us your question so a licensed agent can contact you. Issuance of prior approval is not a guarantee of payment. Mammograms are a key component of a womens preventative care. If you have an HMO or POS plan, there are some additional services you'll need approval for. Copyright 2023 Health Care Service Corporation. Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross Blue Shield Association, serving residents and business in North Dakota. Do practicing North Carolina physicians have input into the program? Preventive Care Plans & Guidelines. Mammograms arent as painful as you think you may feel a little pressure but it only lasts a few seconds. Members must enroll in the multi-call program to qualify for up to 12 weeks of NRT. Did you know that one in eight women will develop invasive breast cancer at some point in her life? Fraud and Abuse Annual physical exams and other preventive services are free when you use a Preferred . This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room. Who can physicians call if they have questions? If physicians have questions about the Blue Cross NC diagnostic imaging management program, they should contact their local Network Management representatives. Barium enema is a covered service but not at 100% so you may have out of pocket costs. Focusing on the right test at the right time for the right patient could save time and mone and increase productivity. $X^ "@\(k'h,@7HI?NH2012|Igl ` |> Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. How do 3D Mammograms Differ From Standard Ones? You usually need to get tested every 3 to 5 years. If you get benefits from your employer, you may also have these benefits. 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. You have coverage from another insurance plan in addition to your Blue Cross and Blue Shield of Nebraska coverage. There are significant concerns about patient safety involved in the increased exposure to radiation due to diagnostic imaging procedures. 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 . Most basis mammogram screenings are covered by your health plan. HMO Scope of Benefits Section . Dynamic contrast material-enhanced MRI may be used to monitor response of a tumor to neoadjuvant chemotherapy used to shrink the tumor before surgery. Hysterectomies are not performed solely for sterilization so are not covered as preventive. This screening is no cost to you. A follow-up study may be considered medically necessary to help evaluate an individual's progress after treatment, procedure, intervention or surgery. The AIM medical guidelines are publicly available and reviewed regularly by radiologists and practicing physicians of many specialties and updated based on the most current medical evidence. One of the goals of this program is to help contain health care costs. If you discuss new medical concerns or a current illness, the entire visit may be considered a medical treatment visit and would not be covered as preventive care. This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs. Screening for Breast Cancer Currently, about 12% of women will develop breast cancer at some point in their lifetime. Why did Blue Cross NC implement a diagnostic imaging management program? We use cookies on this website to give you the best experience and measure website usage. What are the goals of the diagnostic imaging management program? Annual physical exams and other preventive services are free when you use a Preferred provider. We apologize for any inconvenience. The site may also contain non-Medicare related information. The cost of many screenings and checkups is covered at 100% with no out of pocket costs for you and those on your plan. Cancer screenings like colonoscopies and mammograms. 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 Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Take advantage of preventive care and stop problems before they get serious. Your doctor can help you choose a facility thats convenient for you. Your coverage information in the palm of your hand. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services. The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue Shield of Alabama. Preventive Care Guidelines. If you have questions about coverage for preventive services, . Yes, they will cover annual mammograms if they are suitable to age. Select Your Gender. All rights reserved. One option is Adobe Reader which has a built-in screen reader. Your doctor may order a colonoscopy more frequently than every 10 years. Routine physical exams where your doctor reviews the following: This exam is prevention focused, not problem focused. Cost estimates are based only on the coverage you have with us. All Rights Reserved. Fargo, N.D., 58121. Nothing to fear: Its normal to feel scared before any medical procedure, but theres nothing to worry about! Use the subsidy calculator to enter your own . Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : mammograms. Call us at 1-888-243-4420 if you have questions or need help. BRCA is an abbreviation for the BReast CAncer gene, which is an inherited trait. Council and Blue Cross and Blue Shield of . 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. Your Florida Blue Medicare health plan includes a mammogram screening every year for women age 40 and over. 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. As North Dakotans, we can do better in checking for breast cancer. 2021 plans will be available for purchase beginning on November 1, 2020. For example, women who have a family history of breast, cervical or ovarian cancer can be tested for the BRCA1 or BRCA2 genes. If eligible, you must receive genetic counseling and evaluation services before you receive preventive BRCA testing. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . The protection of your privacy will be governed by the privacy policy of that site. 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. These benefits are currently in effect unless otherwise noted. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. 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. Find out what preventive care services are appropriate for you and build a list to share with your doctor. 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. %%EOF Originally published 11/16/2015; Revised 2019, 2022, Get News & Updates Directly To Your Inbox. Blue Care Network HMO and POS members. Since being a carrier is relatively uncommon, doctors usually only test people with a family history of breast or ovarian cancer. You should call the number on the back of your member ID card for more information before you schedule one. 3D mammograms may be covered by your health plan. No lump, no cancer. (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. BATON ROUGE - October is Breast Cancer Awareness Month. 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. It may also be used to depict residual disease after neoadjuvant chemotherapy. Additional mammograms may require cost sharing. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. Even if you're feeling fine, scheduling an appointment with your doctor for preventive care services is important. Still, the overall benefit of 2D and 3D breast cancer screening outweigh any potential risks linked to radiation exposure. CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Which health plans does the program apply to? About one in every seven or eight women gets it in her lifetime. A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. Women who get a 3D mammogram may also get a traditional 2D mammogram, exposing them to higher amounts of radiation. If you have a higher risk for breast cancer, talk to your doctor about screening, no matter how old you are. Immunizations for you and your family. One its drawbacks is breast tissue can overlap during compression. What information is required to request prior approval? Your dashboard may experience future loading problems if not resolved. Breast cancer risk factors include: Check with your doctor if you have questions about mammograms or other breast cancer screenings. Under the Affordable Care Act (ACA), CareFirst and other health insurance carriers must cover a set of preventive serviceslike shots and screening testsand no cost to you. Technical Information 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 These benefits are available for members of non-grandfathered individual health insurance plans. 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. NRT through QuitlineNC is available without a prescription. Health plans are offered by Blue Shield of California. Blue Cross and Blue Shield Federal Employee Program Yesterday at 1:00 PM Simple yet warm, this customizable sheet pan lemon-roasted fish . Others have a false sense of . Did you know preventive health measures and screenings can prevent 85% of illness and disease, and are covered at no cost for many plans?