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Life-Saving: Cancer detection is the key to early treatment and better outcomes. As always, be sure to check your specific plan coverage and see an in-network provider. You are only exposed to a small amount of radiation during a mammogram, and studies show that the benefits of mammograms outweigh any risks. We use cookies on this website to give you the best experience and measure website usage. If so, it should not impact the ability of members to receive these tests. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Tests that do not meet national clinical guidelines will not be approved. Covered: Getting screened wont break the bank. Not all employer groups participate in the diagnostic imaging management program. Learn more about our non-discrimination policy and no-cost services available to you. Originally published 11/16/2015; Revised 2019, 2022, Get News & Updates Directly To Your Inbox. Please review the terms of use and privacy policies of the new site you will be visiting. To view this file, you may need to install a PDF reader program. They are regularly reviewed by physicians of appropriate specialties for consistency with the most recent medical evidence. Mammograms use very small doses of radiation and the risk of harm is very low. Our goal is to review diagnostic imaging tests to determine if each test is clinically appropriate for the specific situation. The scans take detailed X-ray images from many angles. 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. Help Center. These benefits are available for members of non-grandfathered individual health insurance plans. The program is expected to assist Blue Cross NC in improving affordability for our members. 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. It happens in both men and women, but breast cancer in men is not common. The following are the recommended vaccines for women that are covered with no out of pocket cost. During this visit, your doctor examines your overall health. 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. When were Blue Cross NC's diagnostic imaging prior approval policies effective? Will the diagnostic imaging management program increase the risk of malpractice? What information is required to request prior approval? Thanks in part to preventive screenings, there are approximately 2.8 million breast cancer survivors in the U.S. as of 2016. 18.5 - 24.9: healthy weight. Non-Discrimination Statement and Foreign language Access. As a result, 3D mammograms lower the number of false alarms. What clinical criteria does AIM use to determine if a procedure will be approved? 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%. 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. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Blue Cross and Blue Shield Association. Preventive Care: Annual Check-ups, Immunizations & More | BCBSNE Breast cancer is the most common type of cancer in women. Blue Cross and Blue Shield Association . During this visit, your doctor examines your overall health. Who Should Get It: Women age 21 - 65. If physicians have questions about the Blue Cross NC diagnostic imaging management program, they should contact their local Network Management representatives. You usually need to get tested every 3 to 5 years. This screening is no cost to you. Health Insurance Tax Information; Transparency in Coverage; Mental Health Parity; Teledentistry Services Covered; . About one in every seven or eight women gets it in her lifetime. 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. All premiums listed represent coverage for dependents up to age 26. TheU.S. Preventive Services Task Forcerecommends that women between the ages of 50 and 74 get a mammogram every two years. Mammograms use very small doses of radiation and the risk of harm is very low. Will this program impact members' ability to receive the tests they need? 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. Your doctor may order a colonoscopy more frequently than every 10 years. Download the BCBSIL App. Issuance of a prior approval number is not a guarantee of payment. 140 0 obj <>stream Blue Care Network HMO and POS members. 1 If you have gotten one dose of Zostavax vaccine for shingles, you should also get the two doses of Shingrix vaccine. $100 outpatient benefits. Depression screenings. You have coverage from another insurance plan in addition to your Blue Cross and Blue Shield of Nebraska coverage. 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. Did you know that one in eight women will develop invasive breast cancer at some point in her life? It's important for adult women to have annual wellness exams after the age of 21. Returning Shopper? Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. 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). Fraud and Abuse No family history, no risk. Out of network billing can lead to unexpected charges. The U.S. Preventive Services Task Force currently recognizes both 2D and 3D mammography as equally acceptable screening methods. 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. January 25, 2016. NRT through the pharmacy benefit is available only with a prescription. Select Your Gender. 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. These benefits are currently in effect unless otherwise noted. 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. 0 How do 3D Mammograms Differ From Standard Ones? Breast cancer risk factors include: Check with your doctor if you have questions about mammograms or other breast cancer screenings. Echocardiography studies (effective for both Commercial and Blue Medicare HMO\PPO lines of business as of January 2, 2014), Member identification number, name, date of birth, and health plan, Imaging exam(s) being requested (body part, right, left or bilateral), Patient diagnosis (suspected or confirmed), Clinical symptoms/indications (intensity/duration), Results of treatment history (previous tests, duration of previous therapy, relevant clinical medical history), American Institute of Ultrasound in Medicine (AIUM), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare & Medicaid Services (CMS) Local Coverage Determinations (LCD) and National Coverage Determinations (NCD), Promoting and guiding the selection of the most appropriate and cost-effective diagnostic imaging services, Encouraging standardization of medical practice patterns and reducing variation in clinical evaluation, Curtailing the performance of inappropriate diagnostic imaging studies, Advocating biosafety issues, including reduction of clinical radiation exposure (for CT and plain film radiography), Enhancing quality of health care for diagnostic imaging studies using evidence-based medicine and outcomes research from numerous resources. To be covered with no out-of-pocket costs, the service must be: Special information for employees of religious organizations. Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : mammograms. Since their introduction, standard mammograms also called screening mammograms have helped save countless lives. Women ages 40 and older can receive a mammogram (four views) each calendar year. Does this prior approval impact Blue Medicare HMO and Blue Medicare PPO? Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information.

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