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. 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. Blue Cross NC has partnered with American Imaging Management, Inc. (AIM) for the management of outpatient, high-tech diagnostic imaging services. One its drawbacks is breast tissue can overlap during compression. 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. Mammograms | How to Prevent Breast Cancer | BlueCrossMN 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. Did you know that one in eight women will develop invasive breast cancer at some point in her life? Access Your Payment Options. All women need to be informed by their healthcare provider about the best screening options for them. hbbd``b` Please review the terms of use and privacy policies of the new site you will be visiting. This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Your dashboard may experience future loading problems if not resolved. 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. Breast Cancer | Blue Cross and Blue Shield of Texas - BCBSTX You must be at least 18 years old to submit a request. BRCA is an abbreviation for the BReast CAncer gene, which is an inherited trait. No. Most breast cancers are found in women 50 years old and older. These benefits are available for members of non-grandfathered individual health insurance plans. Its common to receive a Pap test (also called a Pap smear or pelvic exam) during your visit. "To put it in perspective, the dose of radiation is lower than that of a chest x-ray," Mehta said. 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. What imaging procedures do NOT require prior approval? Site Map Providers can find complete instructions on how to request prior approval outlined on the diagnostic imaging procedures page. Annual physical exams and other preventive services are free when you use a Preferred . You are leaving this website/app ("site"). One option is Adobe Reader which has a built-in screen reader. 25 - 29.9: overweight. Necesita su ID de usuario? Fraud and Abuse Achieving this requires that we reduce the number of imaging examinations that do not add diagnostic value for members. Fraud and Abuse Returning Shopper? Will the diagnostic imaging management program increase the risk of malpractice? Dental, Life and Disability are offered by Florida Combined Life . Covered: Getting screened wont break the bank. Most basis mammogram screenings are covered by your health plan. Approve annually starting at age 30; Individuals with known BRCA mutation. That's No Excuse: It's Time to Get a Mammogram | Blue Cross Blue Shield Mammogram screening $0 Once per year Nutrition therapy services $0 Ongoing if high risk Mammograms are one of the best ways to find it early. A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. Breast cancer is the second leading cause of cancer deaths among women in the U.S. Compare the prices of 26634 hotels in Ho Chi Minh City, Vietnam. By slowing this growth and containing costs through a proactive diagnostic imaging management program, we anticipate costs savings over time. Preventive vs diagnostic - Arkansas Blue Cross and Blue Shield HMO Scope of Benefits Section . This allows the whole breast to be seen. Should a member request Screening and Diagnostic Mammography & 3D Tomosynthesis - Horizon Blue 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. Barium enema is a covered service but not at 100% so you may have out of pocket costs. Obesity screenings. Does this prior approval impact Blue Medicare HMO and Blue Medicare PPO? Women ages 35-39 can receive one baseline mammogram(four views). Your coverage information in the palm of your hand. File is in portable document format (PDF). Breast cancer is the most widely found cancer in U.S. women, next to skin cancer. 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. Your member ID card is your key to using your medical plan benefits. Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. Additionally, we cover computer-assisted detection for those women who seek an extra level of screening for breast cancer. This Bronze standard plan premium covers 60% of costs. The site may also contain non-Medicare related information. Fortunately, only about 1 in 400 people have a BRCA gene. No family history, no risk. Individuals with a known history of Breast Cancer: Approve initial staging, with treatment [within three (3) months], and yearly surveillance for detection of recurrence or a new cancer. Council and Blue Cross and Blue Shield of . Evaluation of suspected breast cancer when other imaging examinations, such as ultrasound and mammography, and physical examination are inconclusive for the presence of breast cancer, and biopsy could not be performed (e.g. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. PDF Blue Cross and Blue Shield of Illinois Provider Manual - BCBSIL 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. 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. Regular mammograms improve survival rates by 35% in women over 50. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. Breast health screenings | BCBSND Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. Provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions. Estimate Costs: Colonoscopy, Mammogram, MRI & More | BCBSNE - NebraskaBlue Hospitals and freestanding imaging centers that perform the imaging services cannot obtain the approval. Privacy Policy January 25, 2016. A high BMI can be a warning sign for potential health problems. Focusing on the right test at the right time for the right patient could save time and mone and increase productivity. Mammograms are a key component of a womens preventative care. Scenario 2: Your claim for emtricitabine/tenofovir (generic Truvada) or Apretude is not paying at 100% and you are using it for PrEP. It happens in both men and women, but breast cancer in men is not common. If you don't see your insurance plan listed, please contact our Insurance Hotline at 469-398-4099 or email us at insuranceinfo@solismammo.com. Who can physicians call if they have questions? Most Florida Blue plans cover annual screening mammograms for women age 40 and older for as low as a $0 copay. 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. Bacteriuria screening for pregnant women. It's important for adult women to have annual wellness exams after the age of 21. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. 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. In contrast, 3D mammograms use CT (computed tomography) scans. Forgot User ID? You must also receive prior approval from us. Dynamic contrast material-enhanced MRI may be used to monitor response of a tumor to neoadjuvant chemotherapy used to shrink the tumor before surgery. Blue Cross Blue Shield of Massachusetts - Healthy Times - Preventive 104 0 obj <> endobj 2005 - 2022 copyright of Anthem Insurance Companies, Inc. (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. You have coverage from another insurance plan in addition to your Blue Cross and Blue Shield of Nebraska coverage. Only ordering physicians can obtain a prior plan approval number. Blue Cross NC is very aware of the concerns about self-referral. "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. Screening for Cervical Cancer Plus, your medical plan covers 100% of the costs for preventive health services when care is provided through network providers. Mental Health Services. 18.5 - 24.9: healthy weight. No lump, no cancer. Preventive care includes routine well exams, screenings and immunization intended to prevent or avoid illness or other health problems. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . State of South Carolina - Women's Wellness $X^ "@\(k'h,@7HI?NH2012|Igl ` |> Originally published 11/16/2015; Revised 2019, 2022, Get News & Updates Directly To Your Inbox. Accessibility Pays in addition to your other coverages. Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). The protection of your privacy will be governed by the privacy policy of that site. Copy. Your Florida Blue Medicare health plan includes a mammogram screening every year for women age 40 and over. Check out the changes and updates to our plan in 2023. Preventive Care | Blue Cross Blue Shield of Massachusetts A Pap test every 3 years or. Routine physical exams where your doctor reviews the following: This exam is prevention focused, not problem focused. To learn if your patient's plan requires prior approval for these services, please reference the diagnostic imaging procedures page. Our goal is to review diagnostic imaging tests to determine if each test is clinically appropriate for the specific situation. Disponible nicamente en ingls. Health coverage is offered by Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. Find A Doctor Or Hospital In Your Network. However, your group may decide to delay the effective date for coverage until your group's plan . Your doctor will help you decide what schedule makes the most sense for you. When were Blue Cross NC's diagnostic imaging prior approval policies effective? Theyre covered, lifesaving and nothing to fear. 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 . What is 3D Mammography | Blue Cross Blue Shield of Oklahoma Mammography is highly regulated by the Food and Drug Administration, the Mammography Quality and Standards Act and other governing organizations like the American College of Radiology. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. Women ages 35-39 can receive one baseline mammogram (four views).
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