Enrollment in the program is automatic and available to all Blue members. Breast cancer is the most common type of cancer in women. The Federal Patient Protection and Preventive Care Act (PPACA) was passed by Congress and signed into law by the President in March 2010. . Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Thanks in part to preventive screenings, there are approximately 2.8 million breast cancer survivors in the U.S. as of 2016. 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. $X^ "@\(k'h,@7HI?NH2012|Igl ` |> Members must enroll in the multi-call program to qualify for up to 12 weeks of NRT. Please check your coverage with your insurance provider before your appointment with us. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. If you have an HMO or POS plan, there are some additional services you'll need approval for. Does this prior approval impact Blue Medicare HMO and Blue Medicare PPO? The goal of the diagnostic imaging program is to improve affordability of health care to Blue Cross NC members. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the . Our goal is to review diagnostic imaging tests to determine if each test is clinically appropriate for the specific situation. BRCA is an abbreviation for the BReast CAncer gene, which is an inherited trait. No lump, no cancer. 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. Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. 2023 Blue Cross and Blue Shield of North Carolina. This is very important in clinical decision making as alternative therapies may be selected based upon the results obtained from the MRI. By continuing to use this website, you consent to these cookies. Learn more about our non-discrimination policy and no-cost services available to you. Currently, under the Patient Protection and Affordable Care Act Annual Checkups and certain preventive . CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval. File is in portable document format (PDF). Your coverage may vary from the types of benefits listed below. Find out what preventive care services are appropriate for you and build a list to share with your doctor. TheU.S. Preventive Services Task Forcerecommends that women between the ages of 50 and 74 get a mammogram every two years. For example, at the Kapiolani Medical Center [ 1] in Aiea, Hawaii, where the full . Regular mammograms improve survival rates by 35% in women over 50. 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. Women ages 35-39 can receive one baseline mammogram (four views). We can send you an email with information on our health care plans. Heres a deeper dive on the potential benefits and risks of a 3D mammogram. Mammograms are for older women. They can help detect breast cancer up to three years before it can be felt. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. The USPSTF recommends biennial screening mammography for . Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. 4510 13th Ave. S. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. No coverage for oral contraceptive devices. Accessibility Its common to receive a Pap test (also called a Pap smear or pelvic exam) during your visit. This allows the whole breast to be seen. For transgendered individuals, you have access to medically appropriate preventive services. If you get benefits from your employer, you may also have these benefits. Learn more about our non-discrimination policy and no-cost services available to you. MRI findings should be correlated with clinical history, physical examination results, and the results of mammography and any other prior breast imaging. As always, be sure to check your specific plan coverage and see an in-network provider. 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. hbbd``b` Disponible nicamente en ingls. We have an obligation to our members to provide quality care at an affordable price. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. https://www.anthem.com/health-insurance/health-care-reform-resources/reform-law-detail/more-womens-preventive-care-covered?reformlaw=l1019 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. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Coverage Information. Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years. Still, the overall benefit of 2D and 3D breast cancer screening outweigh any potential risks linked to radiation exposure. Learn the facts, and then schedule an appointment today! Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. 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. Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room. 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. HMO Scope of Benefits Section . Some preventive care services require that you meet . Blue Cross and Blue Shield Service Benefit Plan brochures, https://www.mayoclinic.org/tests-procedures/brca-gene-test/about/pac-20384815. 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. To view this file, you may need to install a PDF reader program. Blue Shield of California is an independent member of the Blue Shield Association. Why did Blue Cross NC implement a diagnostic imaging management program? Depression screenings. Standard 2D mammograms take two pictures of the breast. Screenings, tests and other preventive care services Preventive care service Cost . 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. A high BMI can be a warning sign for potential health problems. It happens in both men and women, but breast cancer in men is not common. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. You are viewing estimated values for an individual. Learn more about our non-discrimination policy and no-cost services available to you. As a result, 3D mammograms lower the number of false alarms. What imaging procedures require prior plan approval? Check your Benefit Booklet for details on other preventive care benefits. The scans take detailed X-ray images from many angles. Did you know that one in eight women will develop invasive breast cancer at some point in her life? Has Blue Cross NC considered disallowing self-referrals? Life-Saving: Cancer detection is the key to early treatment and better outcomes. During this visit, your doctor examines your overall health. Not all employer groups participate in the diagnostic imaging management program. "To put it in perspective, the dose of radiation is lower than that of a chest x-ray," Mehta said. The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue Shield of Alabama. 3D mammograms may be covered by your health plan. 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. Covered: Getting screened wont break the bank. Screening for Cervical Cancer For most women, mammogram technology is still considered the best way to detect breast abnormalities and cancers early. Necesita su ID de usuario? 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). 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. Approve annually starting at age 30; Individuals with known BRCA mutation. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. 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. "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. hb```,z@ (Mf`X b`Fe~F9}mS6.awa`\V_RQ g-e0 The age and frequency listed below are general recommendations. The U.S. Preventive Services Task Force currently recognizes both 2D and 3D mammography as equally acceptable screening methods. 30 and above: obese. Heres everything you need to know about it. However, some services like 3D imaging or ultrasounds may not be fully covered the same way. Coverage is subject to the specific terms of the member's benefit plan. But a damaged or broken gene can increase the risk of developing breast cancer. Find an in-network doctor for preventive care. Providers can find complete instructions on how to request prior approval outlined on the diagnostic imaging procedures page. This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Most Florida Blue plans cover annual screening mammograms for women age 40 and older for as low as a $0 copay. Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested. All Rights Reserved. All rights reserved. No family history, no risk. Your doctor will advise on recommended immunizations that can protect against a number of serious diseases. 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. Women between the ages of 40 and 49 should talk to their doctor about when they should start getting mammograms. Some state or federal mandates [e.g., Federal Employee Program (FEP)] prohibits plans from Forgot User ID? About 10% of patients who receive routine mammograms get called back for another look. One option is Adobe Reader which has a built-in reader. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the . Most PDF readers are a free download. Description: clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy. Your member ID card is your key to using your medical plan benefits. Most breast cancers are found in women 50 years old and older. Log In to the Shopping Cart, Need to Make a Payment? Compare the prices of 26634 hotels in Ho Chi Minh City, Vietnam. For evaluation of identified lesion, mass or abnormality in breast in. Use this tool to create personalized recommendations for your . %PDF-1.5 % We recommend receiving estimates close to . Counseling. You must be at least 18 years old to submit a request. . Take advantage of preventive care and stop problems before they get serious. Returning Shopper? There has been an error with your submission. During your visit, your doctor will perform a clinical breast exam. endstream endobj 105 0 obj <. A follow-up study may be considered medically necessary to help evaluate an individual's progress after treatment, procedure, intervention or surgery.