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104 0 obj <> endobj Most breast cancers are found in women 50 years old and older. 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 . listed below will be covered by your plan. NRT through the pharmacy benefit is available only with a prescription. The U.S. Preventive Services Task Force currently recognizes both 2D and 3D mammography as equally acceptable screening methods. For more information, view our privacy policy. Coverage Information. It's important to note that your provider has the right to code and bill services according to his or her viewpoint. Should a member request 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 . 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. 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 dashboard may experience future loading problems if not resolved. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Check your Benefit Booklet for details on other preventive care benefits. This is especially important for women who have dense breast tissue. However, some services like 3D imaging or ultrasounds may not be fully covered the same way. The following are the recommended vaccines for women that are covered with no out of pocket cost. Bacteriuria screening for pregnant women. 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. By Regence. Connect Community - Blue Cross and Blue Shield of Illinois, Radiation treatments to the breast or chest area. Routine physical exams where your doctor reviews the following: This exam is prevention focused, not problem focused. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. To be covered with no out-of-pocket costs, the service must be: Special information for employees of religious organizations. Screening for depression in postpartum women. Screening for high cholesterol is also covered at 100% every 5 years or annually for those with increased risk for CVD. Currently, under the Patient Protection and Affordable Care Act Annual Checkups and certain preventive . Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. The program does not currently apply to FEP, Medicare Supplemental or Medicare Prescription Drug Plans. (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. The cost estimate changed prior to your care. Not all participating DME vendors carry breast pumps. Since their introduction, standard mammograms also called screening mammograms have helped save countless lives. Linked Apps. Compare the prices of 26634 hotels in Ho Chi Minh City, Vietnam. Access Your Payment Options. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California. Why did Blue Cross NC implement a 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. Please review the terms of use and privacy policies of the new site you will be visiting. Inscribirse ahora! 30 and above: obese. Scenario 2: Your claim for emtricitabine/tenofovir (generic Truvada) or Apretude is not paying at 100% and you are using it for PrEP. Breast cancer is the most widely found cancer in U.S. women, next to skin cancer. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. This can get confusing, so call your health plan before you go. Inscribirse ahora! 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. In fact, we rank 32nd out of 50 states. List of all medications that are covered at 100% onall formularies. Will the diagnostic imaging management program increase the risk of malpractice? The USPSTF recommends biennial screening mammography for . 4510 13th Ave. S. Most breast cancers are found in women 50 years old and older. 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. Side-to-side and top-to-bottom images . If eligible, you must receive genetic counseling and evaluation services before you receive preventive BRCA testing. No. "To put it in perspective, the dose of radiation is lower than that of a chest x-ray," Mehta said. They can help detect breast cancer up to three years before it can be felt. 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). 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. All rights reserved. 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. Imaging costs have come to the forefront for employers and health plans because they have been growing at a faster rate than other segments of medical expenditures. Breast Cancer and Early Detection: What Women Need to Know. Nothing to fear: Its normal to feel scared before any medical procedure, but theres nothing to worry about! endstream endobj startxref Please review the terms of use and privacy policies of the new site you will be visiting. . What imaging procedures do NOT require prior approval? Some state or federal mandates [e.g., Federal Employee Program (FEP)] prohibits plans from No coverage for routine physical examinations. Diagnostic mammograms more frequently than once a year, if medically necessary. 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. Approve annually starting at age 30; Individuals not yet tested for BRCA gene, but with known BRCA mutation in first degree relative. About 10% of patients who receive routine mammograms get called back for another look. To learn if your patient's plan requires prior approval for these services, please reference the diagnostic imaging procedures page. Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). Your coverage may vary from the types of benefits listed below. If you have questions about coverage for preventive services, . Some women have a higher risk of developing cancer than other women. We use cookies on this website to give you the best experience and measure website usage. Covered: Getting screened wont break the bank. This colonoscopy will be covered but may not be considered preventive so you may have out of pocket costs. Women ages 40 and older can receive a mammogram (four views) each calendar year. Is the program focused mainly on saving money? Returning Shopper? BATON ROUGE - October is Breast Cancer Awareness Month. You usually need to get tested every 3 to 5 years. Screening for Cervical Cancer Assessing Your Risk Standard 2D mammograms take two pictures of the breast. 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. If you have a higher risk for breast cancer, talk to your doctor about screening, no matter how old you are. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. Some preventive care services require that you meet . Most PDF readers are a free download. For this reason, 2D mammograms can sometimes produce inaccurate findings. While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram. 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) . For most women, mammogram technology is still considered the best way to detect breast abnormalities and cancers early. This is very important in clinical decision making as alternative therapies may be selected based upon the results obtained from the MRI. Council and Blue Cross and Blue Shield of . 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. For transgendered individuals, you have access to medically appropriate preventive services. Privacy Policy 2023 Blue Cross and Blue Shield of North Carolina. If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this. Site Map 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. If you have a positive fecal blood test (gFOBT or FIT or Cologuard) or visualization test (CT colonography or sigmoidoscopy), your doctor may order a follow up colonoscopy. Privacy Policy Learn more about our non-discrimination policy and no-cost services available to you. Description: Screening for cervical cancer. It may also be used to depict residual disease after neoadjuvant chemotherapy. However, sometimes tests are ordered and are not clinically appropriate. As an example, women get regular mammograms at no cost to them as a preventive screening. 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. You will be required to pay the plan's physician office copayment or coinsurance. A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. Genetic counseling and evaluation can help determine if youve inherited a BRCA mutation. Standard 2D mammograms take two pictures of the breast. Cost estimates are based only on the coverage you have with us. Theyre covered, lifesaving and nothing to fear. $100 outpatient benefits. Heres a deeper dive on the potential benefits and risks of a 3D mammogram. endstream endobj 105 0 obj <. Most Florida Blue plans cover annual screening mammograms for women age 40 and older for as low as a $0 copay. Talking with your healthcare provider about the . Others have a false sense of . Issuance of prior approval is not a guarantee of payment. You are leaving this website/app ("site"). MRI findings should be correlated with clinical history, physical examination results, and the results of mammography and any other prior breast imaging. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services, medications and OTC nicotine replacement therapy (NRT), refer to the CDCs posted schedule of immunizations for more information. 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. The protection of your privacy will be governed by the privacy policy of that site. According to the American Cancer Society, our state lags behind much of the nation in mammography screenings. Originally published 11/16/2015; Revised 2019, 2022, Get News & Updates Directly To Your Inbox. Barium enema is a covered service but not at 100% so you may have out of pocket costs. No family history, no risk. There has been an error with your submission. This allows the whole breast to be seen. Description: clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. One option is Adobe Reader which has a built-in reader. Will this program impact members' ability to receive the tests they need? $X^ "@\(k'h,@7HI?NH2012|Igl ` |> This screening is no cost to you. The following contraceptive methods (devices and associated procedures, such as device removal, and pharmaceutical contraceptives) for women with reproductive capacity: Emergency contraception (i.e., morning after pill, Plan B, ella), Effective 8.1.22, one annual subscription to, a prescription from an in-network provider that includes the name of the app, Natural Cycles fertility app, Injections (only covered as preventive for Medoxyprogesterone Acetate 150 mg, which is the only drug and dosage used for contraception), Oral contraceptives (all generic contraceptives will be covered as preventive; brand oral contraceptives will continue to require member cost sharing (e.g., deductible, copay, and/or coinsurance) View a complete, OTC contraceptives (female condoms, all products; sponges, all products; spermicides, all products, male condoms effective 1.1.23), Sterilization procedures including tubal ligation (tying of fallopian tubes) and salpingectomy (removal of fallopian tubes). When were Blue Cross NC's diagnostic imaging prior approval policies effective? Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography (e.g., extremely or heterogeneously dense breasts, implants); A breast cancer risk assessment (by the Gail risk or other validated breast cancer risk assessment models) that identifies the individual as having a lifetime risk of 20% or greater of developing breast cancer (approve annually); Two (2) or more first degree relatives (parents, siblings, and children) have history of breast cancer; Individuals with histories of extensive chest irradiation (usually as treatment for Hodgkin's or other lymphoma.) BRCA is an abbreviation for the BReast CAncer gene, which is an inherited trait. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. However, your group may decide to delay the effective date for coverage until your group's plan . Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. 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. Here's how to interpret your BMI: Below 18.5: underweight. Women ages 40 and older can receive a mammogram (four views) each calendar year. Fewer false alarms reduce unnecessary re-testing along with stress and worry. 2020. . Health Insurance Tax Information; Transparency in Coverage; Mental Health Parity; Teledentistry Services Covered; . Regular mammograms improve survival rates by, Thanks in part to preventive screenings, there are approximately, The average mammogram appointment is just.