blue cross blue shield mammogram coverage blue cross blue shield mammogram coverage

No lump, no cancer. This happens by feeling breast tissue for any lumps or abnormal areas. Wellness service benefits pay you money*. If something is found in a preventive screening mammogram, the screening is still at no cost to the member. During your visit, your doctor will perform a clinical breast exam. Site Map One its drawbacks is breast tissue can overlap during compression. Cancer screenings like colonoscopies and mammograms. 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. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Most breast cancers are found in women 50 years old and older. The policies were effective September 1, 2010 for Blue Medicare HMO and Blue Medicare PPO plans. They can help detect breast cancer up to three years before it can be felt. Your Florida Blue Medicare health plan includes a mammogram screening every year for women age 40 and over. Blue Cross NC will be the fourth company to implement a diagnostic imaging program in North Carolina. If there is a medical reason you cannot use a generic statin, your doctor should review this. 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 . - 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. Nothing to fear: Its normal to feel scared before any medical procedure, but theres nothing to worry about! %%EOF Yes. These benefits are currently in effect unless otherwise noted. Copy. To be covered with no out-of-pocket costs, the service must be: Special information for employees of religious organizations. What to know about breast cancer screenings - Capital Blue Cross Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. . SOURCES: 4510 13th Ave. S. What imaging procedures require prior plan approval? Check out the changes and updates to our plan in 2023. http://www.breastcancer.org/symptoms/understand_bc/statistics Not all employer groups participate in the diagnostic imaging management program. These benefits are available for members of non-grandfathered individual health insurance plans. 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. hb```,z@ (Mf`X b`Fe~F9}mS6.awa`\V_RQ g-e0 Some sites may require you to agree to their terms of use and privacy policy. Preventive vs diagnostic - Arkansas Blue Cross and Blue Shield 1 If you have gotten one dose of Zostavax vaccine for shingles, you should also get the two doses of Shingrix vaccine. 18.5 - 24.9: healthy weight. Learn more about our non-discrimination policy and no-cost services available to you. Screening can help find breast cancer early, when it is easier to treat. Non-Discrimination Statement and Foreign language Access. Only ordering physicians can obtain a prior plan approval number. Serving Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. Your Guide to Women's Preventive Care - FEP Blue What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. BCBSIL Provider Manual June 2020 2 . Mammograms are for older women. So why do so many women put off their mammograms? This screening is no cost to you. Plus, your medical plan covers 100% of the costs for preventive health services when care is provided through network providers. 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. Covered: Getting screened wont break the bank. As North Dakotans, we can do better in checking for breast cancer. For more information, see the Blue Cross and Blue Shield Service Benefit Plan brochures. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. Are you going to reimburse providers for the savings Blue Cross NC will incur? 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. Mammogram screening $0 Once per year Nutrition therapy services $0 Ongoing if high risk The AIM physician reviewer may contact the ordering physician to discuss the case in greater detail within two (2) business days of receipt of the request. Doses, recommended ages and recommended populations vary. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. They can help detect breast cancer up to three years before it can be felt. Learn more about our other insurance plans and Medicare plans, or contact a sales . Select a Region: Please Select One DVEST1 DV9ST1 DV8ST1 DV5ST1 DV4ST1 DV1ST1 DVPST1 DVOST1 DVMST1 DVJST1 DVHST1 DVGST1 DVFST1 DVEST1 DVDST1 DVCST1 LOEST1 Help Center. Coverage - a BCBSMA news service - Blue Cross Blue Shield MA MediaRoom Breast MRI | BCBSND . While 3D mammograms show some promise in better health outcomes, there isnt enough research to advocate them over 2D mammograms. They'll also look for early signs of breast and cervical cancer. Check your Benefit Booklet for details on other preventive care benefits. You should get screenings every one or two years, depending on your doctor's advice. Blue Cross and Blue Shield of Illinois . 30 and above: obese. 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. Since their introduction, standard mammograms also called screening mammograms have helped save countless lives. Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : mammograms. That's No Excuse: It's Time to Get a Mammogram | Blue Cross Blue Shield 2023 Blue Cross and Blue Shield of North Carolina. Side-to-side and top-to-bottom images are made. What is a Religious Organization:A religious organization refers to all employer groups defined under federal law that may limit or not cover contraceptive services due to the type of organization or that have a religious objection to these services. For evaluation of identified lesion, mass or abnormality in breast in. Still, over the past decade, there have been advances in mammogram technology. No. Screening for Breast Cancer The Federal Patient Protection and Preventive Care Act (PPACA) was passed by Congress and signed into law by the President in March 2010. . A mammogram uses an X-ray to examine the breast tissue and can detect changes before you can feel them. . BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Blue Medicare HMO and Blue Medicare PPO (as of September 1, 2010). 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. 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. When it's diagnostic: If your doctor . One option is Adobe Reader which has a built-in screen reader. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Call us at 1-888-243-4420 if you have questions or need help. Others have a false sense of . Blue Shield of California 1999 . You are leaving this website/app ("site"). Did you know preventive health measures and screenings can prevent 85% of illness and disease, and are covered at no cost for many plans? Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. 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. No. We have an obligation to our members to provide quality care at an affordable price. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Standard 2D mammograms take two pictures of the breast. 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. Fargo, N.D., 58121. 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. All rights reserved. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. We will work with the physician community through our Diagnostic Imaging Management Advisory Group to assure that there is no negative impact on the quality of patient care as a result of this initiative. Please utilize the checklist below as a guideline to ensure you have all the necessary information before requesting prior approval: For complex cases, more information may be necessary, including: The diagnostic imaging management process is based upon AIM clinical practice guidelines, developed from consensus opinion in medical practice and integration of medical information from multiple sources, including: The prior approval number will be valid for 30 days from the date issued - not the date of service requested. 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. 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. By using X-rays, they create two-dimensional images of the breast to spot suspicious tissue that may be cancerous. Tests that do not meet national clinical guidelines will not be approved. Description: Screening for cervical cancer. Health plans are offered by Blue Shield of California. Thanks in part to preventive screenings, there are approximately 2.8 million breast cancer survivors in the U.S. as of 2016. External link You are leaving this website/app (site). Blue Care Network HMO and POS members. We apologize for any inconvenience. Use this tool to create personalized recommendations for your . Blue Shield of California is an independent member of the Blue Shield Association. 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. However, your group may decide to delay the effective date for coverage until your group's plan . Fargo (Headquarters) Scroll down to see some common services that may or may not be covered during a preventive care visit. By slowing this growth and containing costs through a proactive diagnostic imaging management program, we anticipate costs savings over time. Coverage is subject to the specific terms of the member's benefit plan. For women with a history of gestational diabetes who are not currently pregnant and who have not previously been diagnosed with type 2 diabetes. If you get benefits from your employer, you may also have these benefits. Should a member request For transgendered individuals, you have access to medically appropriate preventive services. Breast cancer is the second leading cause of cancer deaths among women in the U.S. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. For that reason, benefits for preventive BRCA testing are available for members with a family history of certain cancers. Blue Cross and Blue Shield Federal Employee Program 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. Accessibility Preventive Care Guidelines. Most PDF readers are a free download. "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this. Achieving this requires that we reduce the number of imaging examinations that do not add diagnostic value for members. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the . Do practicing North Carolina physicians have input into the program? Register Now, Ancillary and Specialty Benefits for Employees. Forgot Password? Fortunately, only about 1 in 400 people have a BRCA gene. Cat-scan technology exposes patients to more radiation than an X-rays. Breast cancer is the most common type of cancer in women. listed below will be covered by your plan. Please update your browser if the service fails to run our website. Mammograms use very small doses of radiation and the risk of harm is very low. PDF Anthem Blue Cross and Blue Shield - Portal.ct.gov Routine gynecological visits. 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. There are also additional guidelines if you're pregnant. All Rights Reserved. Screening mammograms every 12 months if you are a woman age 40 or older. Log In to the Shopping Cart, Need to Make a Payment? Understanding your preventive care benefits - Blue Shield of California Learn more about our non-discrimination policy and no-cost services available to you. Imaging costs have come to the forefront for employers and health plans because they have been growing at a faster rate than other segments of medical expenditures. Make sure to get all the screenings and vaccines recommended for your age and gender. Linked Apps. 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. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. Diagnostic mammograms more frequently than once a year, if medically necessary. Forgot User ID? Breast tomosynthesis is an . Barium enema is a covered service but not at 100% so you may have out of pocket costs. 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. 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. TheU.S. Preventive Services Task Forcerecommends that women between the ages of 50 and 74 get a mammogram every two years. Learn the facts, then schedule an appointment today! Blue Cross Blue Shield of Massachusetts - Healthy Times - Preventive Register Now, Ancillary and Specialty Benefits for Employees. Preventive Care Plans & Guidelines. Blue Cross and Blue Shield Association. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Support Transgender services | Blue Cross Blue Shield of Massachusetts There has been an error with your submission. Routine physical exams where your doctor reviews the following: This exam is prevention focused, not problem focused. Screening and Diagnostic Mammography & 3D Tomosynthesis - Horizon Blue endstream endobj startxref Blue Cross and Blue Shield Service Benefit Plan brochures, https://www.mayoclinic.org/tests-procedures/brca-gene-test/about/pac-20384815. Technical Information Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. Summary of Arkansas Blue Cross Blue Shield and Health Advantage Coverage Polices. If you have a higher risk for breast cancer, talk to your doctor about screening, no matter how old you are. This allows the whole breast to be seen. The USPSTF recommends biennial screening mammography for . 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. Breast Cancer and Early Detection: What Women Need to Know. 2020. . Coverage that is supplemental to Medicare but with no member cost How long is an authorization of a diagnostic imaging procedure valid? What imaging procedures do NOT require prior approval? You can also visit our Mental Health Resource . Understand the difference between preventive and diagnostic. 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.