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. Learn more about our non-discrimination policy and no-cost services available to you. Theyre covered, lifesaving and nothing to fear. Fraud and Abuse Most breast cancers are found in women 50 years old and older. We use cookies on this website to give you the best experience and measure website usage. Currently, about 12% of women will develop breast cancer at some point in their lifetime. Select a Region: Please Select One DVEST1 DV9ST1 DV8ST1 DV5ST1 DV4ST1 DV1ST1 DVPST1 DVOST1 DVMST1 DVJST1 DVHST1 DVGST1 DVFST1 DVEST1 DVDST1 DVCST1 LOEST1 This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. What places or settings of treatment are affected? should confirm that a prior approval number has been issued. A follow-up study may be considered medically necessary to help evaluate an individual's progress after treatment, procedure, intervention or surgery. Some preventive care services require that you meet . The Federal Patient Protection and Preventive Care Act (PPACA) was passed by Congress and signed into law by the President in March 2010. . But a damaged or broken gene can increase the risk of developing breast cancer. No lump, no cancer. 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). Screening for high cholesterol is also covered at 100% every 5 years or annually for those with increased risk for CVD. Blue Cross and Blue Shield Federal Employee Program Yesterday at 1:00 PM Simple yet warm, this customizable sheet pan lemon-roasted fish . Prior approval is required by all facilities or settings that offer outpatient, nonemergency diagnostic imaging services. How long is an authorization of a diagnostic imaging procedure valid? Mammograms are a key component of a womens preventative care. 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. recipe is no mess, no fuss and all flavor. BRCA is an abbreviation for the BReast CAncer gene, which is an inherited trait. 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 example, women who have a family history of breast, cervical or ovarian cancer can be tested for the BRCA1 or BRCA2 genes. This information is a reference tool and does not guarantee payment of any claims. 2 The HPV vaccine (Gardasil) is covered to age 45 per the Food and Drug Administration (FDA) guidelines. The protection of your privacy will be governed by the privacy policy of that site. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. 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. 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. 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). You are viewing estimated values for an individual. The site may also contain non-Medicare related information. Insurance. Heres a deeper dive on the potential benefits and risks of a 3D mammogram. Yes. Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years. 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 . For more information, view our privacy policy. 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. Women between the ages of 40 and 49 should talk to their doctor about when they should start getting mammograms. Olvido su contrasea? 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. . Others have a false sense of . What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Sydney Care is offered through an arrangement with Carelon Digital Platforms, Inc. Sydney Health and Sydney Care are service marks of Carelon Digital Platforms, Inc., 2023, http://www.breastcancer.org/symptoms/understand_bc/statistics, https://www.anthem.com/health-insurance/health-care-reform-resources/reform-law-detail/more-womens-preventive-care-covered?reformlaw=l1019, http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. Here's how to interpret your BMI: Below 18.5: underweight. The program does not currently apply to FEP, Medicare Supplemental or Medicare Prescription Drug Plans. Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested. Description: clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy. Technical Information 104 0 obj <> endobj But Humana, which I have now, is even worse because I have a $50 copay just for screening." 3. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. To capture them, the breast is pulled away from the body, compressed and held between two glass plates. Screening for depression in postpartum women. In fact, we rank 32nd out of 50 states. There are also additional guidelines if you're pregnant. Your doctor will collect a sample of cells from your cervix to test for any abnormal or precancerous cells. HMO coverage is offered by Health Options, Inc. DBA Florida Blue HMO. Log In to the Shopping Cart, Need to Make a Payment? January 25, 2016. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Please send us your question so a licensed agent can contact you. Screening for Cervical Cancer You should call the number on the back of your member ID card for more information before you schedule one. For example, at the Kapiolani Medical Center [ 1] in Aiea, Hawaii, where the full . This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. These benefits are available for members of non-grandfathered individual health insurance plans. 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. 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. Check your Benefit Booklet for details on other preventive care benefits. The program is expected to assist Blue Cross NC in improving affordability for our members. Preventive Care Guidelines. The USPSTF recommends biennial screening mammography for . Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the . NRT through the pharmacy benefit is available only with a prescription. Ordering physicians may also contact the AIM physician reviewer at any time during the authorization process. 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. 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 Breast cancer mammography screenings for women over age 40; Colorectal cancer screening for adults over age 45; . Mammograms are for older women. Blue Care Network HMO and POS members. Blue Cross and Blue Shield of Illinois . For women with a history of gestational diabetes who are not currently pregnant and who have not previously been diagnosed with type 2 diabetes. "To put it in perspective, the dose of radiation is lower than that of a chest x . As a result, 3D mammograms lower the number of false alarms. Provider consultation prior to the colonoscopy procedure is covered at 100%. Women ages 35-39 can receive one baseline mammogram (four views). Counseling. Some sites may require you to agree to their terms of use and privacy policy. 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). By Regence. 3D mammograms may be covered by your health plan. Mammograms arent as painful as you think you may feel a little pressure but it only lasts a few seconds. Here's a deeper dive on the potential benefits and risks of a 3D mammogram. If you had a polyps removed during a previous preventive screening colonoscopy, future colonoscopies will be covered but may not be considered preventive so you may have out of pocket costs. All women 40 or older should ask their doctor about when to start getting mammograms and how often theyre needed. The cost estimate changed prior to your care. Find A Doctor Or Hospital In Your Network. Use the subsidy calculator to enter your own . So why do so many women put off their mammograms? Linked Apps. This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs. Who Should Get It: Women age 21 - 65. For that reason, benefits for preventive BRCA testing are available for members with a family history of certain cancers. No prescription medication or NRT limit when received via pharmacy benefit, Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap). 140 0 obj <>stream Psychotherapy. External link You are leaving this website/app (site). Issuance of a prior approval number is not a guarantee of payment. If you have questions about coverage for preventive services, . Examples of these services include: Initial evaluation. No family history, no risk. Learn more about our non-discrimination policy and no-cost services available to you. Privacy Policy BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Your coverage may vary from the types of benefits listed below. Tests that do not meet national clinical guidelines will not be approved. 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. Forgot User ID? Diagnostic care includes care or treatment when you have symptoms or risk factors and your doctor wants to diagnose them. 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. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. Click on a service to see any limits or exclusions. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . BSC6.07 Digital Breast Tomosynthesis. (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. For more information, see the Blue Cross and Blue Shield Service Benefit Plan brochures. How should providers request prior approval? Your doctor can help you choose a facility thats convenient for you. Please review the terms of use and privacy policies of the new site you will be visiting. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. In contrast, 3D mammograms use CT (computed tomography) scans. See your doctor andrefer to the CDCs posted schedule of immunizations for more information. Some buy into dangerous myths about breast cancer. Blue Medicare HMO and Blue Medicare PPO (as of September 1, 2010). Please review the terms of use and privacy policies of the new site you will be visiting. Routine mammograms are covered by the state health plan at no cost to you. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Coverage Information. Blue Shield of California 1999 . The good news is that mammograms can catch cancer early, when its easiest to treat, even if you dont have any symptoms. Some buy into dangerous myths about breast cancer. $X^ "@\(k'h,@7HI?NH2012|Igl ` |> Starting June 1, 2022, this follow up colonoscopy will be covered at 100%. Download the BCBSIL App. Out of network billing can lead to unexpected charges. What imaging procedures do NOT require prior approval? We have an obligation to our members to provide quality care at an affordable price. Call us at 1-888-243-4420 if you have questions or need help. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. 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? $100 outpatient benefits. Copyright 2023 Health Care Service Corporation. 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. %PDF-1.5 % 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.

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