Blue Cross and Blue Shield Federal Employee Program Yesterday at 1:00 PM Simple yet warm, this customizable sheet pan lemon-roasted fish . AIM has a track record of successful experience working with many providers and other Blue Cross and Blue Shield plans across the country. What clinical criteria does AIM use to determine if a procedure will be approved? Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. Most Florida Blue plans cover annual screening mammograms for women age 40 and older for as low as a $0 copay. In contrast, 3D mammograms use CT (computed tomography) scans. Based on clinical criteria, AIM will issue a prior approval number or will forward requests to a nurse or physician if they require further review. For more information, see the Blue Cross and Blue Shield Service Benefit Plan brochures. A follow-up study may be considered medically necessary to help evaluate an individual's progress after treatment, procedure, intervention or surgery. Mental Health Services. This happens by feeling breast tissue for any lumps or abnormal areas. Out of network billing can lead to unexpected charges. Screening for Cervical Cancer Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. If you have an HMO or POS plan, there are some additional services you'll need approval for. For more information, view our privacy policy. Here's how to interpret your BMI: Below 18.5: underweight. The goal of the Blue Cross NC Diagnostic Imaging Program is to improve affordability for Blue Cross NC members. Preventive Care. Privacy Policy , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. You are leaving this website/app ("site"). 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. Check out the changes and updates to our plan in 2023. Negotiated rates with providers can change, therefore, changing the estimate. However, your group may decide to delay the effective date for coverage until your group's plan . There are many easy-to-use BMI calculators online, such as this example from the Centers for Disease Control and Prevention.*. Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. How do 3D Mammograms Differ From Standard Ones? 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. 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. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. About one in every seven or eight women gets it in her lifetime. The protection of your privacy will be governed by the privacy policy of that site. Still, over the past decade, there have been advances in mammogram technology. Covered: Getting screened wont break the bank. Please review the terms of use and privacy policies of the new site you will be visiting. As an example, women get regular mammograms at no cost to them as a preventive screening. Annual physical exams and other preventive services are free when you use a Preferred . Technical Information 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. 2020. . The American Cancer Society recommends women ages 40 to 54 get annual mammograms, and women 55 and older get screenings every two years. Talk to your doctor to find out which of these you should have based on your health. $300 inpatient benefits. How do 3D Mammograms Differ From Standard Ones? Theyre covered, lifesaving and nothing to fear. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. 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. Approve annually starting at age 30; Individuals with known BRCA mutation. 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. It's important for adult women to have annual wellness exams after the age of 21. Theyll also look for early signs of breast and cervical cancer. You should call the number on the back of your member ID card for more information before you schedule one. . Learn the facts, and then schedule an appointment today! Others have a false sense of . Preventive Care Plans & Guidelines. Blue Shield of California is an independent member of the Blue Shield Association. And that means no copays, coinsurance or payment toward your deductible. Originally published 11/16/2015; Revised 2019, 2022, Get News & Updates Directly To Your Inbox. MRI of the breast may be considered medically necessary for individuals with silicone implants whenEITHERof the following are met: MRI of the breast may be considered medically necessary for individuals with no history of known breast cancer, MRI of the breast may be considered medically necessary for individuals with history of known breast cancer. Please check your coverage with your insurance provider before your appointment with us. Does this prior approval impact Blue Medicare HMO and Blue Medicare PPO? It often forms in the tubes that carry milk to the nipple (ducts) and in glands that make milk (lobules). 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. "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 . Blue Cross NC is very aware of the concerns about self-referral. 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There are also additional guidelines if you're pregnant. Use this tool to create personalized recommendations for your . 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. For evaluation of breast lesion, identifying whether single or multi-focal, in individual with diagnosed breast cancer; For evaluation of suspicious mass, lesion, distortion or abnormality of breast in individual with history of breast 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. Breast Cancer. 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. Your member ID card is your key to using your medical plan benefits. We can send you an email with information on our health care plans. 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. The cost estimate changed prior to your care. Necesita su ID de usuario? 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). Ordering physicians may also contact the AIM physician reviewer at any time during the authorization process. 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. $X^
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Health coverage is offered by Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. FDA-approved tobacco cessation prescription. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services. Fargo, N.D., 58121. The diagnostic imaging management program impact is low; why did Blue Cross NC implement it? 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. Mammograms are for older women. One of the goals of this program is to help contain health care costs. However, sometimes tests are ordered and are not clinically appropriate. Your Florida Blue Medicare health plan includes a mammogram screening every year for women age 40 and over. Take advantage of preventive care and stop problems before they get serious. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. Assessing Your Risk Nothing to fear: Its normal to feel scared before any medical procedure, but theres nothing to worry about! Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). Regence supports women's preventive breast health. Non-Discrimination Statement and Foreign language Access. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. Providers can find complete instructions on how to request prior approval outlined on the diagnostic imaging procedures page. Your coverage may vary from the types of benefits listed below. 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 get benefits from your employer, you may also have these benefits. Which health plans does the program apply to? Additionally, the increased use of some high technology imaging procedures creates patient safety concerns from radiation exposure. 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. Easy: Keeping up with your screenings is an important task, even in your busy life. If there is a medical reason you cannot use a generic statin, your doctor should review this. Genetic counseling and evaluation can help determine if youve inherited a BRCA mutation. All rights reserved. But a damaged or broken gene can increase the risk of developing breast cancer. No prescription medication or NRT limit when received via pharmacy benefit, Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap). As a result, 3D mammograms lower the number of false alarms. https://www.anthem.com/health-insurance/health-care-reform-resources/reform-law-detail/more-womens-preventive-care-covered?reformlaw=l1019
Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Blue Shield of California 1999 . To view this file, you may need to install a PDF reader program. It's important to note that your provider has the right to code and bill services according to his or her viewpoint. Mammograms use very small doses of radiation and the risk of harm is very low. (EOB) from Blue Shield of California to notify you that your claim has been processed. You must be at least 18 years old to submit a request. (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. Routine health checkups. Necesita su ID de usuario? 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. Who can physicians call if they have questions? Connect Community - Blue Cross and Blue Shield of Illinois, Radiation treatments to the breast or chest area. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. They are regularly reviewed by physicians of appropriate specialties for consistency with the most recent medical evidence. By continuing to use this website, you consent to these cookies. Health plans are offered by Blue Shield of California. HMO coverage is offered by Health Options, Inc. DBA Florida Blue HMO. Find an in-network doctor for preventive care. By continuing to use this website, you consent to these cookies. Heres everything you need to know about it. 104 0 obj
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Screening can help find breast cancer early, when it is easier to treat. Not all employer groups participate in the diagnostic imaging management program. 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. Help Center. Issuance of a prior approval number is not a guarantee of payment. If you have questions about coverage for preventive services, . Download the BCBSIL App. As we see trends evolve that may impact patient safety, quality of care or affordability, we must implement solutions that protect our members from these trends. The U.S. Preventive Services Task Force currently recognizes both 2D and 3D mammography as equally acceptable screening methods. One its drawbacks is breast tissue can overlap during compression. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. A Pap test every 3 years or. Additional mammograms may require cost sharing. As always, be sure to check your specific plan coverage and see an in-network provider. "To put it in perspective, the dose of radiation is lower than that of a chest x . Coverage is subject to the specific terms of the member's benefit plan. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . Your dashboard may experience future loading problems if not resolved. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. hrHPV test only every 5 years. 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 . SOURCES:
Standard 2D mammograms take two pictures of the breast. Breast cancer risk factors include: Check with your doctor if you have questions about mammograms or other breast cancer screenings. Yes, they will cover annual mammograms if they are suitable to age. Some buy into dangerous myths about breast cancer. Learn more about our other insurance plans and Medicare plans, or contact a sales . Reimbursement Guidelines - Alphabetical Index, Reimbursement Guidelines - Categorical Index, Become a Blue Cross NC Provider or Recredential, Contact Information for Regional Network Management, Responsibilities of Primary Care Physicians (PCP) in 2008, IPP Coordination of Benefits Questionnaire. The issue of return on investment and appropriateness of guidelines will be continually addressed as part of the evaluation of the program. Your doctor can help you choose a facility thats convenient for you. Disponible nicamente en ingls. Side-to-side and top-to-bottom images . http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. Learn more about our non-discrimination policy and no-cost services available to you. They can help detect breast cancer up to three years before it can be felt. What imaging procedures do NOT require prior approval? The site may also contain non-Medicare related information. Some state or federal mandates [e.g., Federal Employee Program (FEP)] prohibits plans from Side-to-side and top-to-bottom images are made. Immunizations for you and your family. Did you know preventive health measures and screenings can prevent 85% of illness and disease, and are covered at no cost for many plans? Women ages 35-39 can receive one baseline mammogram (four views). 25 - 29.9: overweight. 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. Approve annually starting at age 30. Scroll down to see some common services that may or may not be covered during a preventive care visit. 18.5 - 24.9: healthy weight. 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. The policies were effective for diagnostic imaging services performed on or after February 15, 2007 for Blue Cross NC commercial plans. 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. No lump, no cancer. Use the subsidy calculator to enter your own . When it's preventive: You get a mammogram to check for breast cancer. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the . Olvido su contrasea? Additionally, we cover computer-assisted detection for those women who seek an extra level of screening for breast cancer. Plus, your medical plan covers 100% of the costs for preventive health services when care is provided through network providers. According to the American Cancer Society, our state lags behind much of the nation in mammography screenings. Easy: Keeping up with your screenings is an important task, even in your busy life. If you have a higher risk for breast cancer, talk to your doctor about screening, no matter how old you are. Will the diagnostic imaging management program increase the risk of malpractice? Blue Cross NC will be the fourth company to implement a diagnostic imaging program in North Carolina. The following are the recommended vaccines for women that are covered with no out of pocket cost. Will this program impact members' ability to receive the tests they need? Register Now, Ancillary and Specialty Benefits for Employees. After your annual preventive exam, you will receive an Explanation of Benefits (EOB) from Blue Shield of California to notify you that your claim has been processed. 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. 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. Reimbursement Policy: Screening and Diagnostic Mammography & 3D Tomosynthesis Effective Date: April 15, 2017 Last Reviewed Date: February 14, 2023 Purpose: Provide guidelines for the processing of claims for multiple mammograms, CAD and Digital Breast Tomosynthesis (DBT) to align with recent changes to CMS' position on screening and diagnostic mammograms and to define what a mammographic . Select Your Gender. Standard 2D mammograms take two pictures of the breast. All rights reserved. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage.