During this visit, your doctor examines your overall health. Tissue doesnt overlap. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Preventive care includes routine well exams, screenings and immunization intended to prevent or avoid illness or other health problems. 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. The good news is that mammograms can catch cancer early, when its easiest to treat, even if you dont have any symptoms. All women need to be informed by their healthcare provider about the best screening options for them. Privacy Policy Some buy into dangerous myths about breast cancer. These benefits are currently in effect unless otherwise noted. We cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. Standard 2D mammograms take two pictures of the breast. Annual physical exams and other preventive services are free when you use a Preferred provider. HMO Scope of Benefits Section . 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. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Copy. There are significant concerns about patient safety involved in the increased exposure to radiation due to diagnostic imaging procedures. Your member ID card is your key to using your medical plan benefits. Issuance of prior approval is not a guarantee of payment. - 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. "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 . 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. Description: Screening for cervical cancer. What clinical criteria does AIM use to determine if a procedure will be approved? Mammogram screening $0 Once per year Nutrition therapy services $0 Ongoing if high risk Blue Care Network HMO and POS members. Select Your Gender. Has Blue Cross NC considered disallowing self-referrals? All rights reserved. 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. But a damaged or broken gene can increase the risk of developing breast cancer. Some preventive care services require that you meet . Cancer screenings like colonoscopies and mammograms. The age and frequency listed below are general recommendations. During your visit, your doctor will perform a clinical breast exam. Issuance of a prior approval number is not a guarantee of payment. See your doctor andrefer to the CDCs posted schedule of immunizations for more information. If something is found in a preventive screening mammogram, the screening is still at no cost to the member. Coverage Information. 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. You will be required to pay the plan's physician office copayment or coinsurance. Starting June 1, 2022, this follow up colonoscopy will be covered at 100%. 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. 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. Usage Agreement Find out what preventive care services are appropriate for you and build a list to share with your doctor. Annually about 220,000 women are diagnosed with breast cancer. The policies were effective for diagnostic imaging services performed on or after February 15, 2007 for Blue Cross NC commercial plans. The following contraceptive methods (devices and associated procedures, such as device removal, and pharmaceutical contraceptives) for women with reproductive capacity: Emergency contraception (i.e., morning after pill, Plan B, ella), Effective 8.1.22, one annual subscription to, a prescription from an in-network provider that includes the name of the app, Natural Cycles fertility app, Injections (only covered as preventive for Medoxyprogesterone Acetate 150 mg, which is the only drug and dosage used for contraception), Oral contraceptives (all generic contraceptives will be covered as preventive; brand oral contraceptives will continue to require member cost sharing (e.g., deductible, copay, and/or coinsurance) View a complete, OTC contraceptives (female condoms, all products; sponges, all products; spermicides, all products, male condoms effective 1.1.23), Sterilization procedures including tubal ligation (tying of fallopian tubes) and salpingectomy (removal of fallopian tubes). Disponible nicamente en ingls. Inscribirse ahora! Your doctor can help you choose a facility thats convenient for you. 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. Please review the terms of use and privacy policies of the new site you will be visiting. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. 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. No. What places or settings of treatment are affected? https://www.anthem.com/health-insurance/health-care-reform-resources/reform-law-detail/more-womens-preventive-care-covered?reformlaw=l1019
Use the subsidy calculator to enter your own . Generally, practicing consistently with national evidence-based guidelines is expected to reduce errors and liability. A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. If your Summary of Benefits section of your Benefit Booklet contains PREVENTIVE CARE covered under federal law, then you have these benefits at no charge IN-NETWORK. A follow-up study may be considered medically necessary to help evaluate an individual's progress after treatment, procedure, intervention or surgery. For screening examination to detect breast cancer in. Most breast cancers are found in women 50 years old and older. Blue Cross NC will be the fourth company to implement a diagnostic imaging program in North Carolina. It often forms in the tubes that carry milk to the nipple (ducts) and in glands that make milk (lobules). Women ages 40 and older can receive a mammogram (four views) each calendar year. Covered: Getting screened wont break the bank. You are viewing estimated values for an individual. Blue Cross and Blue Shield of Illinois . This can get confusing, so call your health plan before you go. Focusing on the right test at the right time for the right patient could save time and mone and increase productivity. Your dashboard may experience future loading problems if not resolved. About 10% of patients who receive routine mammograms get called back for another look. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). We can send you an email with information on our health care plans. For transgendered individuals, you have access to medically appropriate preventive services. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. 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. Data shows that roughly 30-40% of imaging exams are considered clinically inappropriate or noncontributory. Diagnostic mammograms more frequently than once a year, if medically necessary. Ordering physicians may also contact the AIM physician reviewer at any time during the authorization process. However, if her doctor schedules a follow up mammogram six months later to re-examine that change, it would be used to diagnose a symptom, so it . During this visit, your doctor examines your overall health. Breast Cancer. Ordering physicians for Blue Cross NC members must obtain prior approval prior to scheduling an imaging exam for outpatient diagnostic, non-emergent services. Technical Information So why do so many women put off their mammograms? Scenario 2: Your claim for emtricitabine/tenofovir (generic Truvada) or Apretude is not paying at 100% and you are using it for PrEP. Not all participating DME vendors carry breast pumps. 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. Will this program impact members' ability to receive the tests they need? Learn more about our non-discrimination policy and no-cost services available to you. Routine physical exams where your doctor reviews the following: This exam is prevention focused, not problem focused. 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. This is especially important for women who have dense breast tissue. Why did Blue Cross NC implement a diagnostic imaging management program? 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. They can help detect breast cancer up to three years before it can be felt. There has been an error with your submission. 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. The cost estimate changed prior to your care. Help Center. Heres everything you need to know about it. 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. This new site may be offered by a vendor or an independent third party. The American Cancer Society recommends women ages 40 to 54 get annual mammograms, and women 55 and older get screenings every two years. 104 0 obj
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Cost estimates are based only on the coverage you have with us. 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. Blue Cross NC data confirm there is significant opportunity to contain health care costs and reduce member exposure to radiation by eliminating scans that are clinically inappropriate or noncontributory to the care. Additionally, the increased use of some high technology imaging procedures creates patient safety concerns from radiation exposure. . Talking with your healthcare provider about the . Women ages 40 and older can receive a mammogram (four views) each calendar year. You can also visit our Mental Health Resource . , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Find an in-network doctor for preventive care. should confirm that a prior approval number has been issued. If eligible, you must receive genetic counseling and evaluation services before you receive preventive BRCA testing. 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. MRI findings should be correlated with clinical history, physical examination results, and the results of mammography and any other prior breast imaging. 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). Be sure you're taking full advantage of your coverage. Privacy Policy 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 . Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the . Who can physicians call if they have questions? 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. Tobacco and alcohol use evaluations. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. . In fact, we rank 32nd out of 50 states. Combined together, the X-rays create a three-dimensional picture of each breast. List of all medications that are covered at 100% onall formularies. Register Now, Ancillary and Specialty Benefits for Employees. Learn more about our non-discrimination policy and no-cost services available to you. Some sites may require you to agree to their terms of use and privacy policy. Fargo (Headquarters) Screenings, tests and other preventive care services Preventive care service Cost . Fraud and Abuse In addition, some sites may require you to agree to their terms of use and privacy policy. Dental, Life and Disability are offered by Florida Combined Life . All rights reserved. Technical Information How long is an authorization of a diagnostic imaging procedure valid? And that means no copays, coinsurance or payment toward your deductible. Screening for high cholesterol is also covered at 100% every 5 years or annually for those with increased risk for CVD. Standard 2D mammograms take two pictures of the breast. Check your Benefit Booklet for details on other preventive care benefits. Breast cancer is the most common type of cancer in women. Provider consultation prior to the colonoscopy procedure is covered at 100%. Scroll down to see some common services that may or may not be covered during a preventive care visit. Your member ID card is your key to using your medical plan benefits. Disponible nicamente en ingls. Regular mammograms improve survival rates by 35% in women over 50. Use this tool to create personalized recommendations for your . You usually need to get tested every 3 to 5 years. Should a member request CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval. Even if you're feeling fine, scheduling an appointment with your doctor for preventive care services is important. Forgot Password? Obesity screenings. Others have a false sense of . Breast Cancer Mammography Screening Age 35-39 . Its important for adult women to have annual wellness exams after the age of 21. Select a Region: Please Select One DVEST1 DV9ST1 DV8ST1 DV5ST1 DV4ST1 DV1ST1 DVPST1 DVOST1 DVMST1 DVJST1 DVHST1 DVGST1 DVFST1 DVEST1 DVDST1 DVCST1 LOEST1 For women age 30-65. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Annual physical exams and other preventive services are free when you use a Preferred . For this reason, 2D mammograms can sometimes produce inaccurate findings. Barium enema is a covered service but not at 100% so you may have out of pocket costs. By slowing this growth and containing costs through a proactive diagnostic imaging management program, we anticipate costs savings over time. Site Map Routine gynecological visits. No coverage for oral contraceptive devices. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Will the diagnostic imaging management program increase the risk of malpractice? As always, be sure to check your specific plan coverage and see an in-network provider. Anemia screening for pregnant women. For more information, view our privacy policy. They are regularly reviewed by physicians of appropriate specialties for consistency with the most recent medical evidence. 2023 Blue Cross and Blue Shield of North Carolina. $300 inpatient benefits. Screening mammograms every 12 months if you are a woman age 40 or older. How do 3D Mammograms Differ From Standard Ones? What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. The following are the recommended vaccines for women that are covered with no out of pocket cost. Some women have a higher risk of developing cancer than other women. We apologize for any inconvenience. Learn more about our non-discrimination policy and no-cost services available to you. 2021 plans will be available for purchase beginning on November 1, 2020. Breast cancer is the second leading cause of cancer deaths among women in the U.S. Healthy tissue may appear suspicious and cancerous tissue can be masked. Doses, recommended ages and recommended populations vary.
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