Talking with your healthcare provider about the . 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. Originally published 11/16/2015; Revised 2019, 2022, Get News & Updates Directly To Your Inbox. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Find an in-network doctor for preventive care. CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval. Blue Shield of California 1999 . Recommended repeated Rh (D) antibody testing for all unsensitized Rh (D)-negative women at 2428 weeks gestation unless the biological father is known to be Rh (D)-negative, Anesthesia services will pay at 100% only for sterilization, Certain services for contraceptive device insertion and removal, such as ultrasounds to confirm IUD placement, will pay at 100%, Pregnancy tests prior to the initiation of contraceptive will pay at 100%. Of the 4 million women age 40 to 65 in Texas, 2.6 million . "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. Learn more about our non-discrimination policy and no-cost services available to you. Cost estimates are based only on the coverage you have with us. For evaluation of identified lesion, mass or abnormality in breast in. Clinical breast exam: Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a regular exam by a health professional, at least every three years. Side-to-side and top-to-bottom images . Find out what preventive care services are appropriate for you and build a list to share with your doctor. We can send you an email with information on our health care plans. Please send us your question so a licensed agent can contact you. What imaging procedures require prior plan approval? Breast Cancer and Early Detection: What Women Need to Know. Most breast cancers are found in women 50 years old and older. Another Reason to Get Moving: Exercise Can Help Lower Cancer Risk. Most PDF readers are a free download. It may also be used to depict residual disease after neoadjuvant chemotherapy. 104 0 obj
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Your doctor can help you choose a facility thats convenient for you. How does Blue Cross NC ensure that the program does not negatively impact patient care, divert physicians from the practice of medicine or compromise the patient/physician relationship? 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. 2020. . 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. Anemia screening for pregnant women. Who can physicians call if they have questions? Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . (EOB) from Blue Shield of California to notify you that your claim has been processed. Salpingectomy for sterilization purposes will be covered as preventive effective 7.1.22, Trans-dermal contraceptives (i.e., contraceptive patches), Diaphragms are available only through the pharmacy and IUDs are available only through a professional provider, If there is a medical reason you cannot take a generic contraceptive, your doctor should review this, Diaphragms, vaginal rings, contraceptive patches, female condoms, sponges, spermicides, and emergency contraception are available only with a prescription. Regence supports women's preventive breast health. If so, it should not impact the ability of members to receive these tests. The site may also contain non-Medicare related information. Preventive Care Guidelines. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. You should call the number on the back of your member ID card for more information before you schedule one. Confirmation of silicone gel-filled breast implant ruptures, when this diagnosis cannot be confirmed by mammography or breast ultrasound; For postoperative evaluation of silicone breast implant complications. 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. The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue Shield of Alabama. %%EOF
For that reason, benefits for preventive BRCA testing are available for members with a family history of certain cancers. It often forms in the tubes that carry milk to the nipple (ducts) and in glands that make milk (lobules). A follow-up study may be considered medically necessary to help evaluate an individual's progress after treatment, procedure, intervention or surgery. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. But a damaged or broken gene can increase the risk of developing breast cancer. Healthy tissue may appear suspicious and cancerous tissue can be masked. Side-to-side and top-to-bottom images . This allows the whole breast to be seen. Women ages 35-39 can receive one baseline mammogram(four views). These benefits are currently in effect unless otherwise noted. For example, women who have a family history of breast, cervical or ovarian cancer can be tested for the BRCA1 or BRCA2 genes. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Who reviews requests for diagnostic imaging prior approval? Preventive Care. . 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). We have an obligation to our members to provide quality care at an affordable price. Screening for Breast Cancer Privacy Policy http://www.breastcancer.org/symptoms/understand_bc/statistics
Your dashboard may experience future loading problems if not resolved. Regular mammograms improve survival rates by 35% in women over 50. Examples of these services include: Initial evaluation. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. They are regularly reviewed by physicians of appropriate specialties for consistency with the most recent medical evidence. Who Should Get It: Women age 21 - 65. 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. Routine mammograms are covered by the state health plan at no cost to you. 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. Others have a false sense of . Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). We believe that it is critical to carefully examine the appropriate use of outpatient, nonemergency diagnostic imaging procedures to make sure that the benefit of the procedure outweighs the risk. The cost of many screenings and checkups is covered at 100% with no out of pocket costs for you and those on your plan. Returning Shopper? Routine physical exams where your doctor reviews the following: This exam is prevention focused, not problem focused. Domestic Travel When traveling outside of Vermont you may need access to medical services. 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 . Copy. Breast cancer mammography (at least one baseline mammogram during the 5-year period a member is age 35 through 39 and one mammogram for each member in each calendar year for a member age 40 or older) . Coverage that is supplemental to Medicare but with no member cost Dynamic contrast material-enhanced MRI may be used to monitor response of a tumor to neoadjuvant chemotherapy used to shrink the tumor before surgery. The remaining 40% are out-of-pocket costs. Psychotherapy. Preventive Care Plans & Guidelines. 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. Blue Cross NC is very aware of the concerns about self-referral. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. A mammogram uses an X-ray to examine the breast tissue and can detect changes before you can feel them. And that means no copays, coinsurance or payment toward your deductible. If you have an HMO or POS plan, there are some additional services you'll need approval for. While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram. We apologize for any inconvenience. Provider Manual . Forgot Password? If you have questions about coverage for preventive services, . If there is a medical reason you cannot use a generic statin, your doctor should review this. 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. 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. Technical Information SOURCES:
BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. endstream
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<. Blue Cross and Blue Shield of Illinois . Do practicing North Carolina physicians have input into the program? 2021 plans will be available for purchase beginning on November 1, 2020. 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. There are many easy-to-use BMI calculators online, such as this example from the Centers for Disease Control and Prevention.*. All rights reserved. Non-Discrimination Statement and Foreign language Access. Women who get a 3D mammogram may also get a traditional 2D mammogram, exposing them to higher amounts of radiation. Your browser is not supported. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. to expand insurance coverage for diagnostic mammograms. Should a member request Starting June 1, 2022, this follow up colonoscopy will be covered at 100%. 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.
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