Forgot User ID? BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Mammogram screening $0 Once per year Nutrition therapy services $0 Ongoing if high risk Did you know preventive health measures and screenings can prevent 85% of illness and disease, and are covered at no cost for many plans? Some women have a higher risk of developing cancer than other women. Check your Benefit Booklet for details on other preventive care benefits. endstream endobj startxref What imaging procedures require prior plan approval? 2021 plans will be available for purchase beginning on November 1, 2020. If there is a medical reason you cannot use a generic statin, your doctor should review this. Confirmation of silicone gel-filled breast implant ruptures, when this diagnosis cannot be confirmed by mammography or breast ultrasound; For postoperative evaluation of silicone breast implant complications. Register Now, Ancillary and Specialty Benefits for Employees. 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. Blue Shield of California is an independent member of the Blue Shield Association. So why do so many women put off their mammograms? Who can physicians call if they have questions? Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Bronze Standard - Individual & Family Health Plans 2021 - BCBSWNY 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. listed below will be covered by your plan. PDF Understanding Cost & Coverage Issues - Komen.org Genetic counseling and evaluation can help determine if youve inherited a BRCA mutation. Depression screenings. For more information, view our privacy policy. However, your group may decide to delay the effective date for coverage until your group's plan . Learn more about our non-discrimination policy and no-cost services available to you. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. HMO coverage is offered by Health Options, Inc. DBA Florida Blue HMO. hb```,z@ (Mf`X b`Fe~F9}mS6.awa`\V_RQ g-e0 Women between the ages of 40 and 49 should talk to their doctor about when they should start getting mammograms. BSC6.07 Digital Breast Tomosynthesis. A mammogram uses an X-ray to examine the breast tissue and can detect changes before you can feel them. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. . Wellness service benefits pay you money*. Inscribirse ahora! Preventive Care: Annual Check-ups, Immunizations & More | BCBSNE Screening and Diagnostic Mammography & 3D Tomosynthesis - Horizon Blue During your visit, your doctor will perform a clinical breast exam. These benefits are currently in effect unless otherwise noted. 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. This allows the whole breast to be seen. Council and Blue Cross and Blue Shield of . Still, over the past decade, there have been advances in mammogram technology. . Women ages 35-39 can receive one baseline mammogram (four views). When it's diagnostic: If your doctor . January 25, 2016. Blue Cross and Blue Shield Service Benefit Plan brochures, https://www.mayoclinic.org/tests-procedures/brca-gene-test/about/pac-20384815. 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. Even if you're feeling fine, scheduling an appointment with your doctor for preventive care services is important. Breast cancer is the second leading cause of cancer deaths among women in the U.S. We have an obligation to our members to provide quality care at an affordable price. MRI findings should be correlated with clinical history, physical examination results, and the results of mammography and any other prior breast imaging. But a damaged or broken gene can increase the risk of developing breast cancer. What is 3D Mammography? | Blue Cross Blue Shield of Illinois "To put it in perspective, the dose of radiation is lower than that of a chest x . 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. Your dashboard may experience future loading problems if not resolved. Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. Forgot Password? Easy: Keeping up with your screenings is an important task, even in your busy life. 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. Coverage Policy Manual - Arkansas Blue Cross and Blue Shield Coverage Information | Blue Cross and Blue Shield of Texas Most PDF readers are a free download. This new site may be offered by a vendor or an independent third party. Mammograms | How to Prevent Breast Cancer | BlueCrossMN HMO Scope of Benefits Section . 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 . For most women, mammogram technology is still considered the best way to detect breast abnormalities and cancers early. A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. 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. Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs. To view this file, you may need to install a PDF reader program. Breast cancer mammography screenings for women over age 40; Colorectal cancer screening for adults over age 45; . Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services. The site may also contain non-Medicare related information. 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. Providers can find complete instructions on how to request prior approval outlined on the diagnostic imaging procedures page. (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. Best Answer. Copyright 2023 Health Care Service Corporation. Examples of these services include: Initial evaluation. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. While 3D mammograms show some promise in better health outcomes, there isnt enough research to advocate them over 2D mammograms. That's No Excuse: It's Time to Get a Mammogram | Blue Cross Blue Shield 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. Health Focus: Breast Cancer Prevention | Blue Cross Blue Shield of Alabama "To put it in perspective, the dose of radiation is lower than that of a chest x-ray," Mehta said. Texas insurers to cover advanced breast cancer screenings Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. The Diagnostic Imaging Management Advisory Group is asked to help develop future phases of the diagnostic imaging program, including addressing over-utilization by self-referring physicians as necessary. Its common to receive a Pap test (also called a Pap smear or pelvic exam) during your visit. Here's a deeper dive on the potential benefits and risks of a 3D mammogram. Take advantage of preventive care and stop problems before they get serious. Breast cancer is the most widely found cancer in U.S. women, next to skin cancer. Fraud and Abuse Linked Apps. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue Shield of Alabama. Most breast cancers are found in women 50 years old and older. Regular mammograms improve survival rates by, Thanks in part to preventive screenings, there are approximately, The average mammogram appointment is just. Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room. If you have questions about coverage for preventive services, . Access Your Payment Options. 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 . Screening Saves Lives: Blue Cross Encourages Louisianians to Know Blue Cross NC is very aware of the concerns about self-referral. 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. Preventive Health Care Plans & Guidelines | Anthem.com Olvido su contrasea? No family history, no risk. 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. Breast tomosynthesis is an . Tissue doesnt overlap. We can send you an email with information on our health care plans. When it's preventive: You get a mammogram to check for breast cancer. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. 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. No. 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. 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. 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. Individuals with a known history of Breast Cancer: Approve initial staging, with treatment [within three (3) months], and yearly surveillance for detection of recurrence or a new cancer. Some buy into dangerous myths about breast cancer. Here's how to interpret your BMI: Below 18.5: underweight. Regence supports women's preventive breast health. 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. 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. Which health plans does the program apply to? If you provide a phone number, an agent may call you to make sure that you received the information and to answer any questions that you might have. The scans take detailed X-ray images from many angles. Breast Cancer. 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. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. FDA-approved tobacco cessation prescription. Approve annually starting at age 30; Individuals not yet tested for BRCA gene, but with known BRCA mutation in first degree relative. hbbd``b` Healthy tissue may appear suspicious and cancerous tissue can be masked. Blue Cross and Blue Shield Association . Covered: Getting screened wont break the bank. Site Map Log In to the Shopping Cart, Need to Make a Payment? Bacteriuria screening for pregnant women. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. The U.S. Preventive Services Task Force currently recognizes both 2D and 3D mammography as equally acceptable screening methods. Breast Cancer | Blue Cross and Blue Shield of Texas - BCBSTX There are significant concerns about patient safety involved in the increased exposure to radiation due to diagnostic imaging procedures. Diagnostic care includes care or treatment when you have symptoms or risk factors and your doctor wants to diagnose them. In contrast, 3D mammograms use CT (computed tomography) scans. Annually about 220,000 women are diagnosed with breast cancer. For more information, view our privacy policy. Select a Region: Please Select One DVEST1 DV9ST1 DV8ST1 DV5ST1 DV4ST1 DV1ST1 DVPST1 DVOST1 DVMST1 DVJST1 DVHST1 DVGST1 DVFST1 DVEST1 DVDST1 DVCST1 LOEST1 Heres a deeper dive on the potential benefits and risks of a 3D mammogram. 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. Mammograms are one of the best ways to find it early. Annual physical exams and other preventive services are free when you use a Preferred . The American Cancer Society recommends women ages 40 to 54 get annual mammograms, and women 55 and older get screenings every two years. Fargo (Headquarters) Screening for depression in postpartum women. You must be at least 18 years old to submit a request. We use cookies on this website to give you the best experience and measure website usage. A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. Support Transgender services | Blue Cross Blue Shield of Massachusetts External link You are leaving this website/app (site). Heres everything you need to know about it. 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. Preventive Care Guidelines. Learn more aboutmammogram screeningsin this video. NRT through QuitlineNC is available without a prescription. Your doctor will collect a sample of cells from your cervix to test for any abnormal or precancerous cells. Mammograms are one of the best ways to find it early. (EOB) from Blue Shield of California to notify you that your claim has been processed. 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. For transgendered individuals, you have access to medically appropriate preventive services. Additional mammograms may require cost sharing. Forgot Password? Estimate Costs: Colonoscopy, Mammogram, MRI & More | BCBSNE - NebraskaBlue