All women 40 or older should ask their doctor about when to start getting mammograms and how often theyre needed. 2020. . Routine gynecological visits. About one in every seven or eight women gets it in her lifetime. This screening is no cost to you. Breast MRI should be bilateral except for those with a history of mastectomy or when the MRI is being performed expressly to further evaluate or follow findings in one (1) breast. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Blue Cross and Blue Shield Service Benefit Plan brochures, https://www.mayoclinic.org/tests-procedures/brca-gene-test/about/pac-20384815. During this visit, your doctor examines your overall health. This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs. For that reason, benefits for preventive BRCA testing are available for members with a family history of certain cancers. Theyre covered, lifesaving and nothing to fear. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Ordering physicians for Blue Cross NC members must obtain prior approval prior to scheduling an imaging exam for outpatient diagnostic, non-emergent services. Anemia screening for pregnant women. For women age 30-65. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . A Pap test every 3 years or. 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. You should get screenings every one or two years, depending on your doctor's advice. Assessing Your Risk Pays in addition to your other coverages. Fraud and Abuse 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. Most PDF readers are a free download. Blue Cross NC is the fourth insurer in the state to implement a diagnostic imaging management program, and we understand that our physician community has vital feedback that will help make our program successful. As a result, 3D mammograms lower the number of false alarms. You usually need to get tested every 3 to 5 years. Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years. It is important to note that these services are free only when delivered by a doctor or other . BlueCross BlueShield of South Carolina. Check out the changes and updates to our plan in 2023. 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 2: Your claim for emtricitabine/tenofovir (generic Truvada) or Apretude is not paying at 100% and you are using it for PrEP. While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram. Understand the difference between preventive and diagnostic. 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. Negotiated rates with providers can change, therefore, changing the estimate. %%EOF Please review the terms of use and privacy policies of the new site you will be visiting. Breast Cancer. They'll also look for early signs of breast and cervical cancer. Forgot Password? 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. See your doctor andrefer to the CDCs posted schedule of immunizations for more information. "When a provider recommends getting screened, it indicates the risks outweigh the benefit and it is deemed to be safe," Dallow said, adding that under the . List of all medications that are covered at 100% onall formularies. This new site may be offered by a vendor or an independent third party. They can help detect breast cancer up to three years before it can be felt. Additionally, the increased use of some high technology imaging procedures creates patient safety concerns from radiation exposure. Yes. Even if you're feeling fine, scheduling an appointment with your doctor for preventive care services is important. Learn more about our non-discrimination policy and no-cost services available to you. All rights reserved. Technical 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 . Women ages 40 and older can receive a mammogram (four views) each calendar year. Some sites may require you to agree to their terms of use and privacy policy. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Your doctor will help you decide what schedule makes the most sense for you. All rights reserved. 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 . Please enter a valid date of birth (MM/DD/YYYY), 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, PDF File is in portable document format (PDF). http://www.breastcancer.org/symptoms/understand_bc/statistics 104 0 obj <> endobj Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Thanks in part to preventive screenings, there are approximately 2.8 million breast cancer survivors in the U.S. as of 2016. Blue Cross and Blue Shield of Illinois . 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. Regular mammograms improve survival rates by 35% in women over 50. 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. Obesity screenings. Diagnostic mammograms more frequently than once a year, if medically necessary. 2023 Blue Cross and Blue Shield of North Carolina. "Breast cancer is the most common cancer in American women, but men can also develop breast cancer," said Blue Cross and Blue Shield of . We apologize for any inconvenience. How do 3D Mammograms Differ From Standard Ones? 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. Cost estimates are based only on the coverage you have with us. "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. 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. Life-Saving: Cancer detection is the key to early treatment and better outcomes. Immunizations for you and your family. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. If there is a medical reason you cannot use a generic statin, your doctor should review this. 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). Approve annually starting at age 30; Individuals not yet tested for BRCA gene, but with known BRCA mutation in first degree relative. 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. Standard 2D mammograms take two pictures of the breast. This is very important in clinical decision making as alternative therapies may be selected based upon the results obtained from the MRI. Blue Cross NC has partnered with American Imaging Management, Inc. (AIM) for the management of outpatient, high-tech diagnostic imaging services. 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. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services. Mammograms are for older women. The scans take detailed X-ray images from many angles. 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%. A mammogram uses an X-ray to examine the breast tissue and can detect changes before you can feel them. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Inscribirse ahora! For most women, mammogram technology is still considered the best way to detect breast abnormalities and cancers early. Preventive Care Plans & Guidelines. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. Preventive Care Guidelines. SOURCES: Your dashboard may experience future loading problems if not resolved. External link You are leaving this website/app (site). Register Now, Ancillary and Specialty Benefits for Employees. It happens in both men and women, but breast cancer in men is not common. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Privacy Policy How long is an authorization of a diagnostic imaging procedure valid? Mammograms are one of the best ways to find it early. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. 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. But a damaged or broken gene can increase the risk of developing breast cancer. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . Some women have a higher risk of developing cancer than other women. Most Florida Blue plans cover annual screening mammograms for women age 40 and older for as low as a $0 copay. Check out the changes and updates to our plan in 2023. 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. Fewer false alarms reduce unnecessary re-testing along with stress and worry. Your member ID card is your key to using your medical plan benefits. Site Map Inscribirse ahora! Another Reason to Get Moving: Exercise Can Help Lower Cancer Risk. 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. Heres a deeper dive on the potential benefits and risks of a 3D mammogram. . No. Click on a service to see any limits or exclusions. $100 outpatient benefits. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. The protection of your privacy will be governed by the privacy policy of that site. Accessibility Annual physical exams and other preventive services are free when you use a Preferred . By Regence. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. BSC6.07 Digital Breast Tomosynthesis. Talk to your doctor to find out which of these you should have based on your health. What information is required to request prior approval? Call us at 1-888-243-4420 if you have questions or need help. endstream endobj startxref Description: clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy. How do 3D Mammograms Differ From Standard Ones? Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the . Breast cancer is the most widely found cancer in U.S. women, next to skin cancer. Learn more about our non-discrimination policy and no-cost services available to you. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. This happens by feeling breast tissue for any lumps or abnormal areas. BRCA is an abbreviation for the BReast CAncer gene, which is an inherited trait. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information.