Domestic Travel When traveling outside of Vermont you may need access to medical services. Breast Cancer. Additionally, the increased use of some high technology imaging procedures creates patient safety concerns from radiation exposure. Some buy into dangerous myths about breast cancer. The protection of your privacy will be governed by the privacy policy of that site. Do practicing North Carolina physicians have input into the program? Originally published 11/16/2015; Revised 2019, 2022, Get News & Updates Directly To Your Inbox. 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) . Scenario 1: Brand Truvada, Viread, or Descovy may be made available if you are clinically unable to use generic Truvada. Your member ID card is your key to using your medical plan benefits. These benefits are available for members of non-grandfathered individual health insurance plans. Learn more about our non-discrimination policy and no-cost services available to you. CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval. Breast cancer mammography screenings for women over age 40; Colorectal cancer screening for adults over age 45; . Breast Cancer and Early Detection: What Women Need to Know. Select a Region: Please Select One DVEST1 DV9ST1 DV8ST1 DV5ST1 DV4ST1 DV1ST1 DVPST1 DVOST1 DVMST1 DVJST1 DVHST1 DVGST1 DVFST1 DVEST1 DVDST1 DVCST1 LOEST1 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 . Thanks in part to preventive screenings, there are approximately 2.8 million breast cancer survivors in the U.S. as of 2016. A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. 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. Site Map In contrast, 3D mammograms use CT (computed tomography) scans. Download the BCBSIL App. Under the Affordable Care Act (ACA), CareFirst and other health insurance carriers must cover a set of preventive serviceslike shots and screening testsand no cost to you. Heres everything you need to know about it. Provider Manual . These benefits are currently in effect unless otherwise noted. Easy: Keeping up with your screenings is an important task, even in your busy life. 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. Use this tool to create personalized recommendations for your . "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. Technical Information Achieving this requires that we reduce the number of imaging examinations that do not add diagnostic value for members. Blue Cross and Blue Shield Association . NRT through the pharmacy benefit is available only with a prescription. "Breast cancer is the most common cancer in American women, but men can also develop breast cancer," said Blue Cross and Blue Shield of . MRI of the breast is a useful tool for the detection and characterization of breast disease, assessment of local extent of disease, evaluation of treatment response, and guidance for biopsy and localization. Healthy tissue may appear suspicious and cancerous tissue can be masked. Additionally, we cover computer-assisted detection for those women who seek an extra level of screening for breast cancer. Most PDF readers are a free download. 2021 plans will be available for purchase beginning on November 1, 2020. Provider consultation prior to the colonoscopy procedure is covered at 100%. But a damaged or broken gene can increase the risk of developing breast cancer. Another Reason to Get Moving: Exercise Can Help Lower Cancer Risk. 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. Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. We apologize for any inconvenience. You are viewing estimated values for an individual. Its common to receive a Pap test (also called a Pap smear or pelvic exam) during your visit. Most basis mammogram screenings are covered by your health plan. Covered: Getting screened wont break the bank. You must be at least 18 years old to submit a request. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. However, sometimes tests are ordered and are not clinically appropriate. Learn more aboutmammogram screeningsin this video. Combined together, the X-rays create a three-dimensional picture of each breast. Only ordering physicians can obtain a prior plan approval number. So why do so many women put off their mammograms? endstream endobj startxref There has been an error with your submission. TheU.S. Preventive Services Task Forcerecommends that women between the ages of 50 and 74 get a mammogram every two years. 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. Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). Enrollment in the program is automatic and available to all Blue members. We use cookies on this website to give you the best experience and measure website usage. Connect Community - Blue Cross and Blue Shield of Illinois, Radiation treatments to the breast or chest area. Select Your Gender. . 4510 13th Ave. S. If so, it should not impact the ability of members to receive these tests. Routine health checkups. Here's how to interpret your BMI: Below 18.5: underweight. This screening is no cost to you. Issuance of prior approval is not a guarantee of payment. Approve annually starting at age 30. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. If eligible, you must receive genetic counseling and evaluation services before you receive preventive BRCA testing. Health Insurance Tax Information; Transparency in Coverage; Mental Health Parity; Teledentistry Services Covered; . Side-to-side and top-to-bottom images are made. Some state or federal mandates [e.g., Federal Employee Program (FEP)] prohibits plans from 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. Blue Cross Blue Shield Global Core gives Blue Cross and Blue Shield of Vermont members access to their health care benefits wherever they go - across the country and around the world. What imaging procedures require prior plan approval? Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. All rights reserved. Coverage is subject to the specific terms of the member's benefit plan. Even if you're feeling fine, scheduling an appointment with your doctor for preventive care services is important. Most PDF readers are a free download. It is important to note that these services are free only when delivered by a doctor or other . "To put it in perspective, the dose of radiation is lower than that of a chest x . Scenario 2: Your claim for emtricitabine/tenofovir (generic Truvada) or Apretude is not paying at 100% and you are using it for PrEP. . About 10% of patients who receive routine mammograms get called back for another look. Log In to the Shopping Cart, Need to Make a Payment? To learn if your patient's plan requires prior approval for these services, please reference the diagnostic imaging procedures page. 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. The good news is that mammograms can catch cancer early, when its easiest to treat, even if you dont have any symptoms. endstream endobj 105 0 obj <. Colorectal Cancer . The program will apply to members covered by the following plans: Blue Options SM (group PPO plan), Blue Option HRA (group PPO plan), Blue Options HSA (group and individual PPO plan), Classic Blue (Group CMM plan), Dental Blue (group and individual dental plan), Blue Advantage (individual PPO), Short Term Health Care (individual CMM plan). 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. How long is an authorization of a diagnostic imaging procedure valid? 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. Be sure you're taking full advantage of your coverage. A Pap test every 3 years or. Currently, under the Patient Protection and Affordable Care Act Annual Checkups and certain preventive . Breast cancer risk factors include: Check with your doctor if you have questions about mammograms or other breast cancer screenings. MRI findings should be correlated with clinical history, physical examination results, and the results of mammography and any other prior breast imaging. Check out the changes and updates to our plan in 2023. Find out what preventive care services are appropriate for you and build a list to share with your doctor. While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram. Women ages 40 and older can receive a mammogram (four views) each calendar year. Your doctor will advise on recommended immunizations that can protect against a number of serious diseases. Forgot Password? Anemia screening for pregnant women. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. 122 0 obj <>/Filter/FlateDecode/ID[<13345823F9F84C49978F51E9E4B0DEB3><85AA0C7815CFFF46BE97C496C3A4895B>]/Index[104 37]/Info 103 0 R/Length 89/Prev 75360/Root 105 0 R/Size 141/Type/XRef/W[1 2 1]>>stream Your doctor may order a colonoscopy more frequently than every 10 years. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Diagnostic care includes care or treatment when you have symptoms or risk factors and your doctor wants to diagnose them. The issue of return on investment and appropriateness of guidelines will be continually addressed as part of the evaluation of the program. Theyre covered, lifesaving and nothing to fear. For example, at the Kapiolani Medical Center [ 1] in Aiea, Hawaii, where the full . New health problems discussed with your doctor during your visit, Diagnoses that need to be addressed such as high blood pressure, diabetes, skin rash, and headaches, Breast cancer mammography screenings for women over age 40, Colorectal cancer screening for adults over age 45, Cholesterol screening for adults of certain ages or at higher risk, Additional testing and follow-up procedures if abnormalities are found during mammography or colorectal cancer screenings, Request for a vitamin Dlevel check to test for bone and muscle development and function, Request for a vaccination filter test to determine acceptable amounts of vaccine antibodies in the bloodstream. Mammogram screening $0 Once per year Nutrition therapy services $0 Ongoing if high risk Issuance of a prior approval number is not a guarantee of payment. 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 . Focusing on the right test at the right time for the right patient could save time and mone and increase productivity. The following are the recommended vaccines for women that are covered with no out of pocket cost. If you had a polyps removed during a previous preventive screening colonoscopy, future colonoscopies will be covered but may not be considered preventive so you may have out of pocket costs. Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Your coverage information in the palm of your hand. Regular mammograms improve survival rates by, Thanks in part to preventive screenings, there are approximately, The average mammogram appointment is just. %%EOF Blue Cross NC is very aware of the concerns about self-referral. 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. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. 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. The average mammogram appointment is just 15 minutes long. Your dashboard may experience future loading problems if not resolved. AIM has a track record of successful experience working with many providers and other Blue Cross and Blue Shield plans across the country. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Tissue doesnt overlap. Check out the changes and updates to our plan in 2023. 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. According to the American Cancer Society, our state lags behind much of the nation in mammography screenings. 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 is an abbreviation for Blue Cross and Blue Shield of North Carolina. Am I eligible for these benefits at 100%? Immunizations for you and your family. All women 40 or older should ask their doctor about when to start getting mammograms and how often theyre needed. Examples of these services include: Initial evaluation. Cat-scan technology exposes patients to more radiation than an X-rays. 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 cover mental health services for transgender and gender-diverse members, whether or not you have a mental health diagnosis. . See your doctor andrefer to the CDCs posted schedule of immunizations for more information. The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue Shield of Alabama. The age and frequency listed below are general recommendations. Your doctor can help you choose a facility thats convenient for you. Your doctor will collect a sample of cells from your cervix to test for any abnormal or precancerous cells. Learn more about our non-discrimination policy and no-cost services available to you. 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. Returning Shopper? Mental Health Services. If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this. Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association . 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. 2023 Blue Cross and Blue Shield of North Carolina. Blue Cross and Blue Shield Service Benefit Plan brochures, https://www.mayoclinic.org/tests-procedures/brca-gene-test/about/pac-20384815. hbbd``b` Register Now, Ancillary and Specialty Benefits for Employees. If you have a higher risk for breast cancer, talk to your doctor about screening, no matter how old you are. As North Dakotans, we can do better in checking for breast cancer. Fraud and Abuse 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. Health coverage is offered by Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. This new site may be offered by a vendor or an independent third party. We apologize for any inconvenience. Routine gynecological visits. Cancer screenings like colonoscopies and mammograms. 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. No lump, no cancer. This is very important in clinical decision making as alternative therapies may be selected based upon the results obtained from the MRI. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. 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. Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room. Bacteriuria screening for pregnant women. Fargo (Headquarters) Counseling. 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. Assessing Your Risk 104 0 obj <> endobj Nothing to fear: Its normal to feel scared before any medical procedure, but theres nothing to worry about! Who Should Get It: Women age 40 and older, Who Should Get It: Age 50 - 80 and high risk due to smoking or other exposure, Who Should Get It: Age 10 - 24 with fair skin, Who Should Get It:Women who have personal or family history of breast, ovarian, tubal or peritoneal cancer or ancestry associated with breast cancer susceptibility, Who Should Get It:High-risk women age 35 and older without a prior diagnosis of breast cancer, ductal carcinoma in situ, or lobular carcinoma in situ, Who Should Get It:Women age 5059 under certain conditions, Who Should Get It:Adults aged 35 to 70 who are overweight or obese; certain women after pregnancy, Who Should Get It: Age 18 and older if at increased risk, Who Should Get It:Women age 65 and older, younger high-risk women, Who Should Get It:Adults aged 40-75 with certain risk factors, Who Should Get It:Pregnant women/women who have delivered a baby recently, Who Should Get It:Pregnant women at high risk for Preeclampsia, Who Should Get It: Pregnant and postpartum women, Who Should Get It: Women planning or capable of 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 who are sexually active or thinking about becoming sexually active. But Humana, which I have now, is even worse because I have a $50 copay just for screening." 3. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. The goal of the diagnostic imaging program is to improve affordability of health care to Blue Cross NC members. 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. Talking with your healthcare provider about the . Since being a carrier is relatively uncommon, doctors usually only test people with a family history of breast or ovarian cancer. Blue Cross and Blue Shield of Illinois . FDA-approved tobacco cessation prescription. The policies were effective September 1, 2010 for Blue Medicare HMO and Blue Medicare PPO plans. Learn more about our other insurance plans and Medicare plans, or contact a sales . Non-Discrimination Statement and Foreign language Access. 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. Through a preventive exam and routine health screenings, your doctor can determine your current health status and detect early warning signs of more serious, costly problems. All Rights Reserved. For preoperative evaluation for known breast cancer when surgery planned within thirty (30) days; Evaluation of more than two (2) lesions to optimize surgical planning when requested by surgeon or primary care provider on behalf of surgeon who has seen the individual. External link You are leaving this website/app (site). 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. 2 The HPV vaccine (Gardasil) is covered to age 45 per the Food and Drug Administration (FDA) guidelines. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. 3D mammograms may be covered by your health plan. 18.5 - 24.9: healthy weight. By continuing to use this website, you consent to these cookies. This Bronze standard plan premium covers 60% of costs. One option is Adobe Reader which has a built-in screen reader. 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. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Women ages 40 and older can receive a mammogram (four views) each calendar year. Linked Apps. Should a member request Lumps can be very difficult to feel on your own, which is why its recommended that women over the age of 40 receive regular mammograms. 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. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. There are significant concerns about patient safety involved in the increased exposure to radiation due to diagnostic imaging procedures. The Federal Patient Protection and Preventive Care Act (PPACA) was passed by Congress and signed into law by the President in March 2010. . SOURCES: Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Negotiated rates with providers can change, therefore, changing the estimate. Mammograms are for older women. No family history, no risk. http://www.breastcancer.org/symptoms/understand_bc/statistics You have coverage from another insurance plan in addition to your Blue Cross and Blue Shield of Nebraska coverage. 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.

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