Are you going to reimburse providers for the savings Blue Cross NC will incur? Some state or federal mandates [e.g., Federal Employee Program (FEP)] prohibits plans from . 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. External link You are leaving this website/app (site). Connect Community - Blue Cross and Blue Shield of Illinois, Radiation treatments to the breast or chest area. What process is in place for unfavorable determinations? 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). File is in portable document format (PDF). HMO Scope of Benefits Section . By Regence. endstream endobj 105 0 obj <. The AIM physician reviewer may contact the ordering physician to discuss the case in greater detail within two (2) business days of receipt of the request. Your doctor can help determine your risk level and what steps you should take. Assessing Your Risk Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Who reviews requests for diagnostic imaging prior approval? As a result, 3D mammograms lower the number of false alarms. Diagnostic mammograms more frequently than once a year, if medically necessary. Others have a false sense of . Will this program impact members' ability to receive the tests they need? Privacy Policy During this visit, your doctor examines your overall health. The protection of your privacy will be governed by the privacy policy of that site. Even if you're feeling fine, scheduling an appointment with your doctor for preventive care services is important. Hospitals and freestanding imaging centers that perform the imaging services cannot obtain the approval. Mammograms are a key component of a womens preventative care. Annually about 220,000 women are diagnosed with breast cancer. Cat-scan technology exposes patients to more radiation than an X-rays. Reproduction without authorization from Blue Shield of California is prohibited. Approve annually starting at age 30; Individuals with known BRCA mutation. The remaining 40% are out-of-pocket costs. http://www.breastcancer.org/symptoms/understand_bc/statistics Genetic counseling and evaluation can help determine if youve inherited a BRCA mutation. By continuing to use this website, you consent to these cookies. If you have an HMO or POS plan, there are some additional services you'll need approval for. 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. Understand the difference between preventive and diagnostic. 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 . Note: The Illinois Insurance Code requires all health insurers to provide coverage for mammography, including: one baseline study age 35-39, and an annual mammogram for women 40 and older. To view this file, you may need to install a PDF reader program. Regular mammograms improve survival rates by, Thanks in part to preventive screenings, there are approximately, The average mammogram appointment is just. For women with a history of gestational diabetes who are not currently pregnant and who have not previously been diagnosed with type 2 diabetes. 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. The issue of return on investment and appropriateness of guidelines will be continually addressed as part of the evaluation of the program. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Dental, Life and Disability are offered by Florida Combined Life . 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). The average mammogram appointment is just 15 minutes long. Copyright 2023 Health Care Service Corporation. 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. Talking with your healthcare provider about the . If so, it should not impact the ability of members to receive these tests. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Blue Cross and Blue Shield of Illinois . The program is expected to assist Blue Cross NC in improving affordability for our members. Doses, recommended ages and recommended populations vary. Copy. 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 at high risk of infection or pregnant women, Who Should Get It:Persons at high risk of acquiring HIV, Who Should Get It:Women to age 65 or older if at increased risk, Who Should Get It:Women at high risk of infection and pregnant women, Who Should Get It:Age 18 and older, including pregnant women, Who Should Get It:Women of reproductive age, Who Should Get It:Age 18 and older; when pregnant, Who Should Get It:Women, dependent children up to age 26, pregnant women, Who Should Get It:Women aged 40 to 60 years with normal or overweight body mass index (BMI) of 18.5 - 29.9. January 25, 2016. Your coverage may vary from the types of benefits listed below. Your member ID card is your key to using your medical plan benefits. The Federal Patient Protection and Preventive Care Act (PPACA) was passed by Congress and signed into law by the President in March 2010. . Best Answer. Easy: Keeping up with your screenings is an important task, even in your busy life. Find an in-network doctor for preventive care. 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%. How should providers request prior approval? BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. 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 . Blue Shield of California 1999 . Description: Screening for cervical cancer. We apologize for any inconvenience. should confirm that a prior approval number has been issued. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. HMO coverage is offered by Health Options, Inc. DBA Florida Blue HMO. BRCA is an abbreviation for the BReast CAncer gene, which is an inherited trait. Please send us your question so a licensed agent can contact you. $300 inpatient benefits. This new site may be offered by a vendor or an independent third party. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. BlueCross BlueShield of South Carolina. Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room. Here are some examples: Procedures that may be cosmetic, such as removing scars or excess tissue from your eyes or abdomen; Physical therapy, speech therapy and occupational therapy; Weight-reduction procedures Breast Cancer. Combined together, the X-rays create a three-dimensional picture of each breast. Blue Shield of California is an independent member of the Blue Shield Association. NRT through QuitlineNC is available without a prescription. Non-Discrimination Statement and Foreign language Access. Disponible nicamente en ingls. Women ages 40 and older can receive a mammogram (four views) each calendar year. Summary of Arkansas Blue Cross Blue Shield and Health Advantage Coverage Polices. Mammograms use very small doses of radiation and the risk of harm is very low. Side-to-side and top-to-bottom images . No lump, no cancer. Most PDF readers are a free download. For more information, see the Blue Cross and Blue Shield Service Benefit Plan brochures. Site Map How do 3D Mammograms Differ From Standard Ones? Standard 2D mammograms take two pictures of the breast. What clinical criteria does AIM use to determine if a procedure will be approved? No. Pays in addition to your other coverages. Breast Cancer Mammography Screening Age 35-39 . Which health plans does the program apply to? When it's preventive: You get a mammogram to check for breast cancer. 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). Only ordering physicians can obtain a prior plan approval number. We believe that it is critical to carefully examine the appropriate use of outpatient, nonemergency diagnostic imaging procedures to make sure that the benefit of the procedure outweighs the risk. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. Here's a deeper dive on the potential benefits and risks of a 3D mammogram. Your member ID card is your key to using your medical plan benefits. It may also be used to depict residual disease after neoadjuvant chemotherapy. Colorectal Cancer . Please update your browser if the service fails to run our website. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. Fraud and Abuse Please review the terms of use and privacy policies of the new site you will be visiting. Fraud and Abuse The diagnostic imaging management program impact is low; why did Blue Cross NC implement it? Data shows that roughly 30-40% of imaging exams are considered clinically inappropriate or noncontributory. 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. They'll also look for early signs of breast and cervical cancer. About one in every seven or eight women gets it in her lifetime. This Bronze standard plan premium covers 60% of costs. AIM has a track record of successful experience working with many providers and other Blue Cross and Blue Shield plans across the country. Description: clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy. Most breast cancers are found in women 50 years old and older. Register Now, Ancillary and Specialty Benefits for Employees. Covered: Getting screened wont break the bank. The American Cancer Society recommends women ages 40 to 54 get annual mammograms, and women 55 and older get screenings every two years. Additionally, we cover computer-assisted detection for those women who seek an extra level of screening for breast cancer. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Inscribirse ahora! Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. Screening for high cholesterol is also covered at 100% every 5 years or annually for those with increased risk for CVD. Standard 2D mammograms take two pictures of the breast. Linked Apps. Take advantage of preventive care and stop problems before they get serious. They can help detect breast cancer up to three years before it can be felt. What information is required to request prior approval? You should call the number on the back of your member ID card for more information before you schedule one. Talk to your doctor to find out which of these you should have based on your health. They are regularly reviewed by physicians of appropriate specialties for consistency with the most recent medical evidence. All rights reserved. These benefits are available for members of non-grandfathered individual health insurance plans. 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. Preventive care includes routine well exams, screenings and immunization intended to prevent or avoid illness or other health problems. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. Your coverage information in the palm of your hand. Bacteriuria screening for pregnant women. However, about 72% of women with BRCA1 and about 69% of women with BRCA2 will develop breast cancer by the age of 80. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. 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). 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.) Learn more about our non-discrimination policy and no-cost services available to you. Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. The U.S. Preventive Services Task Force currently recognizes both 2D and 3D mammography as equally acceptable screening methods. All women 40 or older should ask their doctor about when to start getting mammograms and how often theyre needed. %PDF-1.5 % Plus, your medical plan covers 100% of the costs for preventive health services when care is provided through network providers. Mammograms arent as painful as you think you may feel a little pressure but it only lasts a few seconds. All premiums listed represent coverage for dependents up to age 26. Scenario 1: Brand Truvada, Viread, or Descovy may be made available if you are clinically unable to use generic Truvada. . Forgot User ID? Council and Blue Cross and Blue Shield of . Find A Doctor Or Hospital In Your Network. Breast cancer is the second leading cause of cancer deaths among women in the U.S. listed below will be covered by your plan. Still, the overall benefit of 2D and 3D breast cancer screening outweigh any potential risks linked to radiation exposure. Usage Agreement 3D mammograms may be covered by your health plan. Download the BCBSIL App. "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 . A mammogram uses an X-ray to examine the breast tissue and can detect changes before you can feel them. 30 and above: obese. 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. You will be required to pay the plan's physician office copayment or coinsurance. By using X-rays, they create two-dimensional images of the breast to spot suspicious tissue that may be cancerous. 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. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company.
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