. The policies were effective for diagnostic imaging services performed on or after February 15, 2007 for Blue Cross NC commercial plans. 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. Achieving this requires that we reduce the number of imaging examinations that do not add diagnostic value for members. Use this tool to create personalized recommendations for your . What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. The goal of the Blue Cross NC Diagnostic Imaging Program is to improve affordability for Blue Cross NC members. Annually about 220,000 women are diagnosed with breast cancer. Life-Saving: Cancer detection is the key to early treatment and better outcomes. In contrast, 3D mammograms use CT (computed tomography) scans. Insurance. Health plans are offered by Blue Shield of California. Learn more about our non-discrimination policy and no-cost services available to you. The program does not currently apply to FEP, Medicare Supplemental or Medicare Prescription Drug Plans. Many travel vaccines are not covered including: Your doctor will determine what tests or health screenings are needed based on your age, gender, and overall health status. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Blue Shield of California is an independent member of the Blue Shield Association. Nothing to fear: Its normal to feel scared before any medical procedure, but theres nothing to worry about! Still, over the past decade, there have been advances in mammogram technology. Preventive care includes routine well exams, screenings and immunization intended to prevent or avoid illness or other health problems. Which health plans does the program apply to? Will this program impact members' ability to receive the tests they need? This new site may be offered by a vendor or an independent third party. Preventive Care Plans & Guidelines. All rights reserved. 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. Necesita su ID de usuario? What process is in place for unfavorable determinations? Your doctor can help determine your risk level and what steps you should take. 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. Site Map Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Anemia screening for pregnant women. The policies were effective September 1, 2010 for Blue Medicare HMO and Blue Medicare PPO plans. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. (EOB) from Blue Shield of California to notify you that your claim has been processed. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . Copy. The cost estimate changed prior to your care. By Regence. Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. What places or settings of treatment are affected? During your visit, your doctor will perform a clinical breast exam. The USPSTF recommends biennial screening mammography for . Approve annually starting at age 30; Individuals not yet tested for BRCA gene, but with known BRCA mutation in first degree relative. "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. TheU.S. Preventive Services Task Forcerecommends that women between the ages of 50 and 74 get a mammogram every two years. Site Map Forgot User ID? Talking with your healthcare provider about the . In addition, some sites may require you to agree to their terms of use and privacy policy. recipe is no mess, no fuss and all flavor. Check out the changes and updates to our plan in 2023. All premiums listed represent coverage for dependents up to age 26. 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. Blue Cross and Blue Shield of Illinois . Learn the facts, and then schedule an appointment today! Coverage Information. 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. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. A high BMI can be a warning sign for potential health problems. Call us at 1-888-243-4420 if you have questions or need help. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Linked Apps. Linked Apps. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Mammograms are one of the best ways to find it early. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Most PDF readers are a free download. Screening can help find breast cancer early, when it is easier to treat. Cat-scan technology exposes patients to more radiation than an X-rays. Blue Medicare HMO and Blue Medicare PPO (as of September 1, 2010). HMO Scope of Benefits Section . 2020. . Most breast cancers are found in women 50 years old and older. 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. 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). Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). http://www.breastcancer.org/symptoms/understand_bc/statistics Domestic Travel When traveling outside of Vermont you may need access to medical services. 3D mammograms may be covered by your health plan. Data shows that roughly 30-40% of imaging exams are considered clinically inappropriate or noncontributory. You are viewing estimated values for an individual. 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 . To capture them, the breast is pulled away from the body, compressed and held between two glass plates. 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. Routine physical exams where your doctor reviews the following: This exam is prevention focused, not problem focused. Providers can find complete instructions on how to request prior approval outlined on the diagnostic imaging procedures page. Heres a deeper dive on the potential benefits and risks of a 3D mammogram. Not all employer groups participate in the diagnostic imaging management program. 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. $X^ "@\(k'h,@7HI?NH2012|Igl ` |> Plus, your medical plan covers 100% of the costs for preventive health services when care is provided through network providers. This information is a reference tool and does not guarantee payment of any claims. Olvido su contrasea? Your Florida Blue Medicare health plan includes a mammogram screening every year for women age 40 and over. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. 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. Talk to your doctor to find out which of these you should have based on your health. Fraud and Abuse Wellness service benefits pay you money*. Breast cancer is the most widely found cancer in U.S. women, next to skin cancer. Regence supports women's preventive breast health. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. External link You are leaving this website/app (site). No family history, no risk. Coverage that is supplemental to Medicare but with no member cost Inscribirse ahora! When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. Ordering physicians for Blue Cross NC members must obtain prior approval prior to scheduling an imaging exam for outpatient diagnostic, non-emergent services. NRT through QuitlineNC is available without a prescription. Some providers charge more, and some offer an uninsured discount. Check out the changes and updates to our plan in 2023. 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. 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. As a result, we believe that Blue Cross NC is taking an important step for patient safety and in managing increased costs by implementing a diagnostic imaging managing program. Inscribirse ahora! Blue Cross and Blue Shield of Louisiana joins other healthcare organizations in reminding Louisianians how important it is to know your personal health risks and ask your doctor about screening. endstream endobj startxref 104 0 obj <> endobj The protection of your privacy will be governed by the privacy policy of that site. 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. Routine mammograms are covered by the state health plan at no cost to you. Regular mammograms improve survival rates by, Thanks in part to preventive screenings, there are approximately, The average mammogram appointment is just. 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 NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. We recommend receiving estimates close to . Accessibility Learn more about our non-discrimination policy and no-cost services available to you. By slowing this growth and containing costs through a proactive diagnostic imaging management program, we anticipate costs savings over time. Assessing Your Risk Breast cancer is the second leading cause of cancer deaths among women in the U.S. %%EOF Barium enema is a covered service but not at 100% so you may have out of pocket costs. What imaging procedures require prior plan approval? During this visit, your doctor examines your overall health. Technical Information Technical Information Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years. 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. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the . Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.
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