Yes. Breast cancer is the most widely found cancer in U.S. women, next to skin cancer. 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. This new site may be offered by a vendor or an independent third party. Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. Select Your Gender. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Learn more about our non-discrimination policy and no-cost services available to you. Still, the overall benefit of 2D and 3D breast cancer screening outweigh any potential risks linked to radiation exposure. The cost of many screenings and checkups is covered at 100% with no out of pocket costs for you and those on your plan. What process is in place for unfavorable determinations? Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested. All premiums listed represent coverage for dependents up to age 26. (EOB) from Blue Shield of California to notify you that your claim has been processed. Obesity screenings. Bacteriuria screening for pregnant women. 30 and above: obese. Examples of these services include: Initial evaluation. Healthy tissue may appear suspicious and cancerous tissue can be masked. No coverage for routine physical examinations. Technical Information To view this file, you may need to install a PDF reader program. Insurance. They can help detect breast cancer up to three years before it can be felt. Achieving this requires that we reduce the number of imaging examinations that do not add diagnostic value for members. Reproduction without authorization from Blue Shield of California is prohibited. Help Center. Are you going to reimburse providers for the savings Blue Cross NC will incur? $100 outpatient benefits. Some women have a higher risk of developing cancer than other women. Additional mammograms may require cost sharing. Accessibility Some buy into dangerous myths about breast cancer. Some preventive care services require that you meet . Tobacco and alcohol use evaluations. 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. Blue Cross and Blue Shield of Louisiana joins other healthcare organizations in reminding Louisianians how important it is to know your personal health risks and ask your doctor about screening. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. You should get screenings every one or two years, depending on your doctor's advice. Screening can help find breast cancer early, when it is easier to treat. Another Reason to Get Moving: Exercise Can Help Lower Cancer Risk. Limited to a 90 day supply each for two cessation efforts. 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. 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. This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Inscribirse ahora! To view this file, you may need to install a PDF reader program. Talk to your doctor to find out which of these you should have based on your health. Call us at 1-888-243-4420 if you have questions or need help. The goal of the Blue Cross NC Diagnostic Imaging Program is to improve affordability for Blue Cross NC members. 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. A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. There are significant concerns about patient safety involved in the increased exposure to radiation due to diagnostic imaging procedures. "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 . Find an in-network doctor for preventive care. 4510 13th Ave. S. Counseling. Providers can find complete instructions on how to request prior approval outlined on the diagnostic imaging procedures page. Yes, they will cover annual mammograms if they are suitable to age. One its drawbacks is breast tissue can overlap during compression. No prescription medication or NRT limit when received via pharmacy benefit, Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap). How should providers request prior approval? The program is expected to assist Blue Cross NC in improving affordability for our members. Standard 2D mammograms take two pictures of the breast. What places or settings of treatment are affected? January 25, 2016. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. Covered: Getting screened wont break the bank. Combined together, the X-rays create a three-dimensional picture of each breast. 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 require prior plan approval? Screening for Cervical Cancer So why do so many women put off their mammograms? 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 Your member ID card is your key to using your medical plan benefits. Our goal is to review diagnostic imaging tests to determine if each test is clinically appropriate for the specific situation. Provider Manual . Screening for high cholesterol is also covered at 100% every 5 years or annually for those with increased risk for CVD. (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. It often forms in the tubes that carry milk to the nipple (ducts) and in glands that make milk (lobules). For this reason, 2D mammograms can sometimes produce inaccurate findings. Issuance of a prior approval number is not a guarantee of payment. BSC6.07 Digital Breast Tomosynthesis. Colorectal Cancer . hbbd``b` Necesita su ID de usuario? Understand the difference between preventive and diagnostic. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. It is important to note that these services are free only when delivered by a doctor or other . File is in portable document format (PDF). For example, women who have a family history of breast, cervical or ovarian cancer can be tested for the BRCA1 or BRCA2 genes. The issue of return on investment and appropriateness of guidelines will be continually addressed as part of the evaluation of the program. Women ages 40 and older can receive a mammogram (four views) each calendar year. Which health plans does the program apply to? Blue Cross and Blue Shield Association. 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. Most PDF readers are a free download. 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. 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. Learn more about our non-discrimination policy and no-cost services available to you. Forgot Password? When were Blue Cross NC's diagnostic imaging prior approval policies effective? For more information, view our privacy policy. If there is a medical reason you cannot use a generic statin, your doctor should review this. However, some services like 3D imaging or ultrasounds may not be fully covered the same way. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. If physicians have questions about the Blue Cross NC diagnostic imaging management program, they should contact their local Network Management representatives. The program does not currently apply to FEP, Medicare Supplemental or Medicare Prescription Drug Plans. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Others have a false sense of . Find your ideal accommodation from hundreds of great deals and save with www.trivago.com We apologize for any inconvenience. Mammograms are for older women. Others have a false sense of . 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. 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. Depression screenings. By continuing to use this website, you consent to these cookies. This new site may be offered by a vendor or an independent third party. The goal of the diagnostic imaging program is to improve affordability of health care to Blue Cross NC members. Learn more about our other insurance plans and Medicare plans, or contact a sales . Did you know preventive health measures and screenings can prevent 85% of illness and disease, and are covered at no cost for many plans? Breast tomosynthesis is an . You must be at least 18 years old to submit a request. HMO Scope of Benefits Section . During this visit, your doctor examines your overall health. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services. Members must enroll in the multi-call program to qualify for up to 12 weeks of NRT. 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. When it's diagnostic: If your doctor . %%EOF Tissue doesnt overlap. 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. 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. . Blue Cross and Blue Plus health plans cover both 2D and 3D preventive screening mammograms at no cost to members when you use an in-network provider. Inscribirse ahora! Fortunately, only about 1 in 400 people have a BRCA gene. 2021 plans will be available for purchase beginning on November 1, 2020. Hysterectomies are not performed solely for sterilization so are not covered as preventive. There are many easy-to-use BMI calculators online, such as this example from the Centers for Disease Control and Prevention.*. Coverage that is supplemental to Medicare but with no member cost 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. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. No family history, no risk. Coverage is subject to the specific terms of the member's benefit plan. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. Since being a carrier is relatively uncommon, doctors usually only test people with a family history of breast or ovarian cancer. Do practicing North Carolina physicians have input into the program? 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). . Here's a deeper dive on the potential benefits and risks of a 3D mammogram. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. Breast cancer mammography (at least one baseline mammogram during the 5-year period a member is age 35 through 39 and one mammogram for each member in each calendar year for a member age 40 or older) . mammogram for women between ages 35-39. If so, it should not impact the ability of members to receive these tests. 2023 Blue Cross and Blue Shield of North Carolina. 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). Scroll down to see some common services that may or may not be covered during a preventive care visit. By Regence. Mammograms are a key component of a womens preventative care. Additionally, we cover computer-assisted detection for those women who seek an extra level of screening for breast cancer. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . As North Dakotans, we can do better in checking for breast cancer. 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. Your doctor will collect a sample of cells from your cervix to test for any abnormal or precancerous cells. . Your browser is not supported. Some sites may require you to agree to their terms of use and privacy policy. Most Florida Blue plans cover annual screening mammograms for women age 40 and older for as low as a $0 copay. 3D mammograms may be covered by your health plan. Log In to the Shopping Cart, Need to Make a Payment? FDA-approved tobacco cessation prescription. Mental Health Services. We have an obligation to our members to provide quality care at an affordable price. Coverage Information. 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. 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. Preventive care includes routine well exams, screenings and immunization intended to prevent or avoid illness or other health problems. 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. For more information, see the Blue Cross and Blue Shield Service Benefit Plan brochures. Please update your browser if the service fails to run our website. 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. Originally published 11/16/2015; Revised 2019, 2022, Get News & Updates Directly To Your Inbox. A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. Additional Screenings for High-Risk Women Site Map The diagnostic imaging management program impact is low; why did Blue Cross NC implement it? Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. Of the 4 million women age 40 to 65 in Texas, 2.6 million . Dynamic contrast material-enhanced MRI may be used to monitor response of a tumor to neoadjuvant chemotherapy used to shrink the tumor before surgery. Women ages 35-39 can receive one baseline mammogram(four views). Blue Cross NC is very aware of the concerns about self-referral. Will the diagnostic imaging management program increase the risk of malpractice? Even if you're feeling fine, scheduling an appointment with your doctor for preventive care services is important. 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. MRI of the breast is a useful tool for the detection and characterization of breast disease, assessment of local extent of disease, evaluation of treatment response, and guidance for biopsy and localization. While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram.
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