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This Bronze standard plan premium covers 60% of costs. Olvido su contrasea? Check your Benefit Booklet for details on other preventive care benefits. 2020. . The cost of many screenings and checkups is covered at 100% with no out of pocket costs for you and those on your plan. There are significant concerns about patient safety involved in the increased exposure to radiation due to diagnostic imaging procedures. Coverage is subject to the specific terms of the member's benefit plan. Take advantage of preventive care and stop problems before they get serious. Blue Cross NC is very aware of the concerns about self-referral. (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. Site Map As an example, women get regular mammograms at no cost to them as a preventive screening. 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. Check out the changes and updates to our plan in 2023. No. hbbd``b` You should call the number on the back of your member ID card for more information before you schedule one. Some Blue Cross NCmembers who are employees of religious organizations and their dependents: Talk to your employer or check your benefit booklet to confirm your coverage for these benefits and any limitations. External link You are leaving this website/app (site). 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. Learn more about our non-discrimination policy and no-cost services available to you. Issuance of prior approval is not a guarantee of payment. Standard 2D mammograms take two pictures of the breast. When were Blue Cross NC's diagnostic imaging prior approval policies effective? Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). To learn if your patient's plan requires prior approval for these services, please reference the diagnostic imaging procedures page. 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 Medicare PPO plans): Prior approval is not required when these procedures are performed in an emergency room, hospital (related to an inpatient or observation stay), urgent care center or ambulatory surgical center. Reproduction without authorization from Blue Shield of California is prohibited. The diagnostic imaging management program guidelines are based on the most up-to-date recommendations of physician organizations such as the American College of Radiology and the American College of Cardiology. Ordering physicians may also contact the AIM physician reviewer at any time during the authorization process. Salpingectomy for sterilization purposes will be covered as preventive effective 7.1.22, Trans-dermal contraceptives (i.e., contraceptive patches), Diaphragms are available only through the pharmacy and IUDs are available only through a professional provider, If there is a medical reason you cannot take a generic contraceptive, your doctor should review this, Diaphragms, vaginal rings, contraceptive patches, female condoms, sponges, spermicides, and emergency contraception are available only with a prescription. You should get screenings every one or two years, depending on your doctor's advice. Starting June 1, 2022, this follow up colonoscopy will be covered at 100%. 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? Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Theyll also look for early signs of breast and cervical cancer. Provider consultation prior to the colonoscopy procedure is covered at 100%. Blue Care Network HMO and POS members. Screening can help find breast cancer early, when it is easier to treat. . Of the 4 million women age 40 to 65 in Texas, 2.6 million . It is important to note that these services are free only when delivered by a doctor or other . Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. The goal of the diagnostic imaging program is to improve affordability of health care to Blue Cross NC members. You usually need to get tested every 3 to 5 years. The program will apply to members covered by the following plans: Blue Options SM (group PPO plan), Blue Option HRA (group PPO plan), Blue Options HSA (group and individual PPO plan), Classic Blue (Group CMM plan), Dental Blue (group and individual dental plan), Blue Advantage (individual PPO), Short Term Health Care (individual CMM plan). This information is a reference tool and does not guarantee payment of any claims. No coverage for routine physical examinations. 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 . During this visit, your doctor examines your overall health. 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. The policies were effective for diagnostic imaging services performed on or after February 15, 2007 for Blue Cross NC commercial plans. 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. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . Women ages 40 and older can receive a mammogram (four views) each calendar year. http://www.breastcancer.org/symptoms/understand_bc/statistics Mammograms are for older women. 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). 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. So why do so many women put off their mammograms? January 25, 2016. 2023 Blue Cross and Blue Shield of North Carolina. Frequency: May vary based on your health so ask your doctor, Certain breast pumps for pregnant and post-partum women, One manual or electric breast pump purchase per pregnancy is covered, Benefit available during third trimester (starting 11.1.16) or after member has delivered the baby, Breast pumps come with certain supplies, such as tubing, shields and bottles, Breast pumps must be purchased from participating Durable Medical Equipment (DME) vendors. What imaging procedures do NOT require prior approval? This happens by feeling breast tissue for any lumps or abnormal areas. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. 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. *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 . No coverage for oral contraceptive devices. Side-to-side and top-to-bottom images . Disponible nicamente en ingls. Olvido su contrasea? Heres everything you need to know about it. 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). How long is an authorization of a diagnostic imaging procedure valid? Some preventive care services require that you meet . Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested. While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram. 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. Who Should Get It: Women age 21 - 65. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Anemia screening for pregnant women. Approve annually starting at age 30; Individuals with known BRCA mutation. The good news is that mammograms can catch cancer early, when its easiest to treat, even if you dont have any symptoms. You must also receive prior approval from us. If you get benefits from your employer, you may also have these benefits. SOURCES: Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Inscribirse ahora! Depression screenings. 2 The HPV vaccine (Gardasil) is covered to age 45 per the Food and Drug Administration (FDA) guidelines. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. For example, women who have a family history of breast, cervical or ovarian cancer can be tested for the BRCA1 or BRCA2 genes. 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. Fargo (Headquarters) Some state or federal mandates [e.g., Federal Employee Program (FEP)] prohibits plans from These benefits are currently in effect unless otherwise noted. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Scenario 2: Your claim for emtricitabine/tenofovir (generic Truvada) or Apretude is not paying at 100% and you are using it for PrEP. The American Cancer Society recommends women ages 40 to 54 get annual mammograms, and women 55 and older get screenings every two years. Coverage Information. HMO Scope of Benefits Section . Heres a deeper dive on the potential benefits and risks of a 3D mammogram. Screening for Breast Cancer Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services. Compare the prices of 26634 hotels in Ho Chi Minh City, Vietnam. Mammograms are one of the best ways to find it early. Some sites may require you to agree to their terms of use and privacy policy. You will be required to pay the plan's physician office copayment or coinsurance. Am I eligible for these benefits at 100%? Its common to receive a Pap test (also called a Pap smear or pelvic exam) during your visit. Breast Cancer and Early Detection: What Women Need to Know. Healthy tissue may appear suspicious and cancerous tissue can be masked. Yes, they will cover annual mammograms if they are suitable to age. 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. How should providers request prior approval? Doses, recommended ages and recommended populations vary. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. 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. Blue Medicare HMO and Blue Medicare PPO (as of September 1, 2010). 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.