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

30 and above: obese. Blue Cross and Blue Shield Association . Fraud and Abuse There are also additional guidelines if you're pregnant. Routine health checkups. You usually need to get tested every 3 to 5 years. 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. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. 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. 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. During your visit, your doctor will determine what tests or health screenings are right for you based on factors such as your age, gender, health status, and health and family history. This screening is no cost to you. Find A Doctor Or Hospital In Your Network. Women ages 35-39 can receive one baseline mammogram(four views). Provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Help Center. Psychotherapy. Coverage that is supplemental to Medicare but with no member cost 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. Learn the facts, and then schedule an appointment today! Find your ideal accommodation from hundreds of great deals and save with www.trivago.com A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. %PDF-1.5 % Our goal is to review diagnostic imaging tests to determine if each test is clinically appropriate for the specific situation. We can send you an email with information on our health care plans. Women who get a 3D mammogram may also get a traditional 2D mammogram, exposing them to higher amounts of radiation. Regular mammograms improve survival rates by, Thanks in part to preventive screenings, there are approximately, The average mammogram appointment is just. 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. Preventive Care. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Blue Shield of California is an independent member of the Blue Shield Association. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the . This can get confusing, so call your health plan before you go. All Rights Reserved. The protection of your privacy will be governed by the privacy policy of that site. Reproduction without authorization from Blue Shield of California is prohibited. All rights reserved. Take advantage of preventive care and stop problems before they get serious. Breast cancer is the most common type of cancer in women. Learn more about our non-discrimination policy and no-cost services available to you. Enrollment in the program is automatic and available to all Blue members. Some state or federal mandates [e.g., Federal Employee Program (FEP)] prohibits plans from Yes. Easy: Keeping up with your screenings is an important task, even in your busy life. BlueCross BlueShield of South Carolina. In contrast, 3D mammograms use CT (computed tomography) scans. Most breast cancers are found in women 50 years old and older. All premiums listed represent coverage for dependents up to age 26. According to the American Cancer Society, our state lags behind much of the nation in mammography screenings. Summary of Arkansas Blue Cross Blue Shield and Health Advantage Coverage Polices. Since being a carrier is relatively uncommon, doctors usually only test people with a family history of breast or ovarian cancer. http://www.breastcancer.org/symptoms/understand_bc/statistics Cat-scan technology exposes patients to more radiation than an X-rays. Fargo (Headquarters) Women ages 40 and older can receive a mammogram (four views) each calendar year. Women ages 40 and older can receive a mammogram (four views) each calendar year. 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. 2023 Blue Cross and Blue Shield of North Carolina. No coverage for routine physical examinations. Others have a false sense of . Learn the facts, then schedule an appointment today! 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. For women with a history of gestational diabetes who are not currently pregnant and who have not previously been diagnosed with type 2 diabetes. Starting June 1, 2022, this follow up colonoscopy will be covered at 100%. One option is Adobe Reader which has a built-in reader. In fact, we rank 32nd out of 50 states. You are leaving this website/app ("site"). 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. This happens by feeling breast tissue for any lumps or abnormal areas. Is the program focused mainly on saving money? 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. They can help detect breast cancer up to three years before it can be felt. The program does not currently apply to FEP, Medicare Supplemental or Medicare Prescription Drug Plans. There are many easy-to-use BMI calculators online, such as this example from the Centers for Disease Control and Prevention.*. Blue Cross and Blue Shield of Louisiana joins other healthcare organizations in reminding Louisianians how important it is to know your personal health risks and ask your doctor about screening. Thanks in part to preventive screenings, there are approximately 2.8 million breast cancer survivors in the U.S. as of 2016. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services. Most PDF readers are a free download. The American Cancer Society recommends women ages 40 to 54 get annual mammograms, and women 55 and older get screenings every two years. Cost estimates are based only on the coverage you have with us. 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. See your doctor andrefer to the CDCs posted schedule of immunizations for more information. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. 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. %%EOF The site may also contain non-Medicare related information. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. Diagnostic care includes care or treatment when you have symptoms or risk factors and your doctor wants to diagnose them. Breast cancer is the second leading cause of cancer deaths among women in the U.S. Side-to-side and top-to-bottom images . Domestic Travel When traveling outside of Vermont you may need access to medical services. It often forms in the tubes that carry milk to the nipple (ducts) and in glands that make milk (lobules). It may also be used to depict residual disease after neoadjuvant chemotherapy. Your coverage may vary from the types of benefits listed below. Dental, Life and Disability are offered by Florida Combined Life . Hysterectomies are not performed solely for sterilization so are not covered as preventive. $300 inpatient benefits. What clinical criteria does AIM use to determine if a procedure will be approved? Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography (e.g., extremely or heterogeneously dense breasts, implants); A breast cancer risk assessment (by the Gail risk or other validated breast cancer risk assessment models) that identifies the individual as having a lifetime risk of 20% or greater of developing breast cancer (approve annually); Two (2) or more first degree relatives (parents, siblings, and children) have history of breast cancer; Individuals with histories of extensive chest irradiation (usually as treatment for Hodgkin's or other lymphoma.) Forgot User ID? 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. Coverage Information. 4510 13th Ave. S. Access Your Payment Options. HMO coverage is offered by Health Options, Inc. DBA Florida Blue HMO. Necesita su ID de usuario? During your visit, your doctor will perform a clinical breast exam. $100 outpatient benefits. Heres everything you need to know about it. 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. Anemia screening for pregnant women. Many travel vaccines are not covered including: Your doctor will determine what tests or health screenings are needed based on your age, gender, and overall health status. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. FDA-approved tobacco cessation prescription. For example, at the Kapiolani Medical Center [ 1] in Aiea, Hawaii, where the full . Click on a service to see any limits or exclusions. For evaluation of identified lesion, mass or abnormality in breast in. 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. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. If you have a higher risk for breast cancer, talk to your doctor about screening, no matter how old you are. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Dynamic contrast material-enhanced MRI may be used to monitor response of a tumor to neoadjuvant chemotherapy used to shrink the tumor before surgery. 18.5 - 24.9: healthy weight. Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room. 2020. . Some women have a higher risk of developing cancer than other women. Your doctor will collect a sample of cells from your cervix to test for any abnormal or precancerous cells. Your doctor will help you decide what schedule makes the most sense for you. Copy. Negotiated rates with providers can change, therefore, changing the estimate. Find out what preventive care services are appropriate for you and build a list to share with your doctor. How do 3D Mammograms Differ From Standard Ones? $X^ "@\(k'h,@7HI?NH2012|Igl ` |> 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. Not all participating DME vendors carry breast pumps. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. NRT through QuitlineNC is available without a prescription. 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. Provided by an in-network doctor or facility (urgent care facility, outpatient clinic or ambulatory surgery center), Filed by your doctor as a preventive care visit, Identified as preventive care under the Affordable Care Act (ACA), In women age 2129 with cervial cytology (pap test) every 3 years, A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. Copyright 2023 Health Care Service Corporation. 104 0 obj <> endobj BCBSIL Provider Manual June 2020 2 . Routine physical exams where your doctor reviews the following: This exam is prevention focused, not problem focused. Please review the terms of use and privacy policies of the new site you will be visiting. Blue Medicare HMO and Blue Medicare PPO (as of September 1, 2010). For more information, see the Blue Cross and Blue Shield Service Benefit Plan brochures. https://www.anthem.com/health-insurance/health-care-reform-resources/reform-law-detail/more-womens-preventive-care-covered?reformlaw=l1019