Blue Cross NC created a Diagnostic Imaging Advisory Group, which includes North Carolina physicians who order and render radiology services and representatives of major medical organizations, to allow for medical community feedback. All rights reserved. No family history, no risk. By continuing to use this website, you consent to these cookies. 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. For preoperative evaluation for known breast cancer when surgery planned within thirty (30) days; Evaluation of more than two (2) lesions to optimize surgical planning when requested by surgeon or primary care provider on behalf of surgeon who has seen the individual. Copy. Most breast cancers are found in women 50 years old and older. The site may also contain non-Medicare related information. Necesita su ID de usuario? Blue Cross NC will be the fourth company to implement a diagnostic imaging program in North Carolina. Select a Region: Please Select One DVEST1 DV9ST1 DV8ST1 DV5ST1 DV4ST1 DV1ST1 DVPST1 DVOST1 DVMST1 DVJST1 DVHST1 DVGST1 DVFST1 DVEST1 DVDST1 DVCST1 LOEST1 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. If you get benefits from your employer, you may also have these benefits. No coverage for oral contraceptive devices. Women ages 40 and older can receive a mammogram (four views) each calendar year. Your doctor may order a colonoscopy more frequently than every 10 years. Who Should Get It: Women age 21 - 65. 0 Non-Discrimination Statement and Foreign language Access. Forgot Password? This happens by feeling breast tissue for any lumps or abnormal areas. Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room. Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. There are many easy-to-use BMI calculators online, such as this example from the Centers for Disease Control and Prevention.*. File is in portable document format (PDF). Select Your Gender. During this visit, your doctor examines your overall health. Currently, about 12% of women will develop breast cancer at some point in their lifetime. Screening mammograms every 12 months if you are a woman age 40 or older. Screening for depression in postpartum women. 104 0 obj <> endobj Additional mammograms may require cost sharing. Linked Apps. Annual physical exams and other preventive services are free when you use a Preferred . 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. Disponible nicamente en ingls. Some women have a higher risk of developing cancer than other women. Who reviews requests for diagnostic imaging prior approval? This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. But Humana, which I have now, is even worse because I have a $50 copay just for screening." 3. The site may also contain non-Medicare related information. Additional Screenings for High-Risk Women endstream endobj startxref A mammogram uses an X-ray to examine the breast tissue and can detect changes before you can feel them. AIM has a track record of successful experience working with many providers and other Blue Cross and Blue Shield plans across the country. The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue Shield of Alabama. Find A Doctor Or Hospital In Your Network. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. - 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. All premiums listed represent coverage for dependents up to age 26. Immunizations for you and your family. Obesity screenings. Did you know that one in eight women will develop invasive breast cancer at some point in her life? . Blue Shield of California 1999 . About 10% of patients who receive routine mammograms get called back for another look. And that means no copays, coinsurance or payment toward your deductible. The cost of many screenings and checkups is covered at 100% with no out of pocket costs for you and those on your plan. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Here's how to interpret your BMI: Below 18.5: underweight. Pays cash if you're treated for cancer. Issuance of a prior approval number is not a guarantee of payment. Fargo (Headquarters) Council and Blue Cross and Blue Shield of . Even if you're feeling fine, scheduling an appointment with your doctor for preventive care services is important. TheU.S. Preventive Services Task Forcerecommends that women between the ages of 50 and 74 get a mammogram every two years. Reproduction without authorization from Blue Shield of California is prohibited. Most breast cancers are found in women 50 years old and older. When were Blue Cross NC's diagnostic imaging prior approval policies effective? Technical Information Prior approval is required by all facilities or settings that offer outpatient, nonemergency diagnostic imaging services. We apologize for any inconvenience. They can help detect breast cancer up to three years before it can be felt. 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. 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. All rights reserved. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . BlueCross BlueShield of South Carolina. Use the subsidy calculator to enter your own . Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the . 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. Take advantage of preventive care and stop problems before they get serious. Healthy tissue may appear suspicious and cancerous tissue can be masked. Diagnostic care includes care or treatment when you have symptoms or risk factors and your doctor wants to diagnose them. We have an obligation to our members to provide quality care at an affordable price. Diagnostic mammograms more frequently than once a year, if medically necessary. Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. %%EOF Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested. Does this prior approval impact Blue Medicare HMO and Blue Medicare PPO? Description: clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy. Only ordering physicians can obtain a prior plan approval number. Mammograms are one of the best ways to find it early. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. 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. Lumps can be very difficult to feel on your own, which is why its recommended that women over the age of 40 receive regular mammograms. Note: The Illinois Insurance Code requires all health insurers to provide coverage for mammography, including: one baseline study age 35-39, and an annual mammogram for women 40 and older. The cost estimate changed prior to your care. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Learn more about our non-discrimination policy and no-cost services available to you. Scenario 2: Your claim for emtricitabine/tenofovir (generic Truvada) or Apretude is not paying at 100% and you are using it for PrEP. Limited to a 90 day supply each for two cessation efforts. 140 0 obj <>stream "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. Psychotherapy. Learn more aboutmammogram screeningsin this video. 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. Telligent is an operating division of Verint Americas, Inc., an independent company that provides and hosts an online community platform for blogging and access to social media for Blue Cross and Blue Shield of Illinois. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. to expand insurance coverage for diagnostic mammograms. 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. Please check your coverage with your insurance provider before your appointment with us. Screening for Breast Cancer HMO Scope of Benefits Section . https://www.anthem.com/health-insurance/health-care-reform-resources/reform-law-detail/more-womens-preventive-care-covered?reformlaw=l1019 Dental, Life and Disability are offered by Florida Combined Life . 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. As we see trends evolve that may impact patient safety, quality of care or affordability, we must implement solutions that protect our members from these trends. Fraud and Abuse Not all employer groups participate in the diagnostic imaging management program. No. One its drawbacks is breast tissue can overlap during compression. Is the program focused mainly on saving money? They are regularly reviewed by physicians of appropriate specialties for consistency with the most recent medical evidence. NRT through the pharmacy benefit is available only with a prescription. Mammograms use very small doses of radiation and the risk of harm is very low. Reimbursement Guidelines - Alphabetical Index, Reimbursement Guidelines - Categorical Index, Become a Blue Cross NC Provider or Recredential, Contact Information for Regional Network Management, Responsibilities of Primary Care Physicians (PCP) in 2008, IPP Coordination of Benefits Questionnaire. Most basis mammogram screenings are covered by your health plan. By slowing this growth and containing costs through a proactive diagnostic imaging management program, we anticipate costs savings over time. Breast Cancer. Data shows that roughly 30-40% of imaging exams are considered clinically inappropriate or noncontributory. Yes. BATON ROUGE - October is Breast Cancer Awareness Month. For example, women who have a family history of breast, cervical or ovarian cancer can be tested for the BRCA1 or BRCA2 genes. Easy: Keeping up with your screenings is an important task, even in your busy life. 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. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. 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. Most PDF readers are a free download. hb```,z@ (Mf`X b`Fe~F9}mS6.awa`\V_RQ g-e0 Blue Medicare HMO and Blue Medicare PPO (as of September 1, 2010). Disponible nicamente en ingls. For most women, mammogram technology is still considered the best way to detect breast abnormalities and cancers early. They'll also look for early signs of breast and cervical cancer. This information is a reference tool and does not guarantee payment of any claims. Your doctor will advise on recommended immunizations that can protect against a number of serious diseases. Health Insurance Tax Information; Transparency in Coverage; Mental Health Parity; Teledentistry Services Covered; . 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. Description: Screening for cervical cancer. Out of network billing can lead to unexpected charges. No prescription medication or NRT limit when received via pharmacy benefit, Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap). As a result, 3D mammograms lower the number of false alarms. Your coverage information in the palm of your hand. Be sure you're taking full advantage of your coverage. Understand the difference between preventive and diagnostic. 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. Preventive Care. Women who get a 3D mammogram may also get a traditional 2D mammogram, exposing them to higher amounts of radiation.
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