Connect Community - Blue Cross and Blue Shield of Illinois, Radiation treatments to the breast or chest area. This new site may be offered by a vendor or an independent third party. Your doctor will help you decide what schedule makes the most sense for you. To be covered with no out-of-pocket costs, the service must be: Special information for employees of religious organizations. Blue Shield of California is an independent member of the Blue Shield Association. Standard 2D mammograms take two pictures of the breast. Inscribirse ahora! Breast cancer is the most widely found cancer in U.S. women, next to skin cancer. 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. Your doctor will advise on recommended immunizations that can protect against a number of serious diseases. 25 - 29.9: overweight. No. For most women, mammogram technology is still considered the best way to detect breast abnormalities and cancers early. Copyright 2023 Health Care Service Corporation. 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). should confirm that a prior approval number has been issued. "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 . 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 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. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. 104 0 obj <> endobj We use cookies on this website to give you the best experience and measure website usage. Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : mammograms. 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. 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. Necesita su ID de usuario? Council and Blue Cross and Blue Shield of . However, some services like 3D imaging or ultrasounds may not be fully covered the same way. Understand the difference between preventive and diagnostic. How do 3D Mammograms Differ From Standard Ones? The goal of the Blue Cross NC Diagnostic Imaging Program is to improve affordability for Blue Cross NC members. Blue Shield of California 1999 . Breast Cancer. In contrast, 3D mammograms use CT (computed tomography) scans. You have coverage from another insurance plan in addition to your Blue Cross and Blue Shield of Nebraska coverage. Ordering physicians may also contact the AIM physician reviewer at any time during the authorization process. You can also visit our Mental Health Resource . Blue Care Network HMO and POS members. 30 and above: obese. Forgot User ID? The cost estimate changed prior to your care. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. This Bronze standard plan premium covers 60% of costs. BSC6.07 Digital Breast Tomosynthesis. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. They'll also look for early signs of breast and cervical cancer. 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. Most basis mammogram screenings are covered by your health plan. 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. *Applicable Wellness Screenings: $50 benefit paid one time per year, per insured (age 18 and over) for breast ultrasound, breast MRI, mammograms, CA 15-3 . 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. But a damaged or broken gene can increase the risk of developing breast cancer. You are viewing estimated values for an individual. To view this file, you may need to install a PDF reader program. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. Diagnostic mammograms more frequently than once a year, if medically necessary. Focusing on the right test at the right time for the right patient could save time and mone and increase productivity. While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram. Health Insurance Tax Information; Transparency in Coverage; Mental Health Parity; Teledentistry Services Covered; . And that means no copays, coinsurance or payment toward your deductible. It may also be used to depict residual disease after neoadjuvant chemotherapy. Learn more about our non-discrimination policy and no-cost services available to you. Side-to-side and top-to-bottom images are made. Coverage is subject to the specific terms of the member's benefit plan. No coverage for oral contraceptive devices. Regular mammograms improve survival rates by 35% in women over 50. This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs. Site Map Typical costs: For an uninsured patient, typical full-price cost of a mammogram ranges from $80 to $120 or more, with an average of about $102, according to Blue Cross Blue Shield of North Carolina. MRI findings should be correlated with clinical history, physical examination results, and the results of mammography and any other prior breast imaging. 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. Select Your Gender. Breast Cancer Mammography Screening Age 35-39 . 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. For women with a history of gestational diabetes who are not currently pregnant and who have not previously been diagnosed with type 2 diabetes. Still, the overall benefit of 2D and 3D breast cancer screening outweigh any potential risks linked to radiation exposure. According to the American Cancer Society, our state lags behind much of the nation in mammography screenings. The age and frequency listed below are general recommendations. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. Here's a deeper dive on the potential benefits and risks of a 3D mammogram. Pays cash if you're treated for cancer. Some preventive care services require that you meet . Most Florida Blue plans cover annual screening mammograms for women age 40 and older for as low as a $0 copay. All women 40 or older should ask their doctor about when to start getting mammograms and how often theyre needed. But Humana, which I have now, is even worse because I have a $50 copay just for screening." 3. There are many easy-to-use BMI calculators online, such as this example from the Centers for Disease Control and Prevention.*. Does this prior approval impact Blue Medicare HMO and Blue Medicare PPO? Preventive Care. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Most PDF readers are a free download. 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. 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 As a result, 3D mammograms lower the number of false alarms. hb```,z@ (Mf`X b`Fe~F9}mS6.awa`\V_RQ g-e0 It happens in both men and women, but breast cancer in men is not common. To view this file, you may need to install a PDF reader program. Check your Benefit Booklet for details on other preventive care benefits. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Description: clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in 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 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. Fargo (Headquarters) See your doctor andrefer to the CDCs posted schedule of immunizations for more information. Find an in-network doctor for preventive care. mammogram for women between ages 35-39. A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. During this visit, your doctor examines your overall health. Covered: Getting screened wont break the bank. Nothing to fear: Its normal to feel scared before any medical procedure, but theres nothing to worry about! endstream endobj 105 0 obj <. As an example, women get regular mammograms at no cost to them as a preventive screening. Who Should Get It: Women age 21 - 65. For example, women who have a family history of breast, cervical or ovarian cancer can be tested for the BRCA1 or BRCA2 genes. Blue Cross NC is very aware of the concerns about self-referral. Who can physicians call if they have questions? For women age 30-65. If there is a medical reason you cannot use a generic statin, your doctor should review this. All rights reserved. Annual physical exams and other preventive services are free when you use a Preferred . Preventive Care Plans & Guidelines. Your doctor can help you choose a facility thats convenient for you. By continuing to use this website, you consent to these cookies. Please review the terms of use and privacy policies of the new site you will be visiting. Check out the changes and updates to our plan in 2023. Privacy Policy Generally, practicing consistently with national evidence-based guidelines is expected to reduce errors and liability. 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.
