Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . 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. They can help detect breast cancer up to three years before it can be felt. 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. Some Blue Cross NCmembers who are employees of religious organizations and their dependents: Talk to your employer or check your benefit booklet to confirm your coverage for these benefits and any limitations. Since being a carrier is relatively uncommon, doctors usually only test people with a family history of breast or ovarian cancer. For screening examination to detect breast cancer in. http://www.breastcancer.org/symptoms/understand_bc/statistics Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. We have an obligation to our members to provide quality care at an affordable price. Blue Cross NC will be the fourth company to implement a diagnostic imaging program in North Carolina. Women ages 35-39 can receive one baseline mammogram(four views). During your visit, your doctor will determine what tests or health screenings are right for you based on factors such as your age, gender, health status, and health and family history. So why do so many women put off their mammograms? You are only exposed to a small amount of radiation during a mammogram, and studies show that the benefits of mammograms outweigh any risks. Blue Shield of California 1999 . Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Others have a false sense of . Theyll also look for early signs of breast and cervical cancer. Returning Shopper? Your Florida Blue Medicare health plan includes a mammogram screening every year for women age 40 and over. 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) . We use cookies on this website to give you the best experience and measure website usage. 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. BATON ROUGE - October is Breast Cancer Awareness Month. Annual physical exams and other preventive services are free when you use a Preferred provider. Health Insurance Tax Information; Transparency in Coverage; Mental Health Parity; Teledentistry Services Covered; . , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. State of South Carolina - Women's Wellness What places or settings of treatment are affected? So why do so many women put off their mammograms? 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 . Side-to-side and top-to-bottom images . 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. This is especially important for women who have dense breast tissue. Psychotherapy. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Members must enroll in the multi-call program to qualify for up to 12 weeks of NRT. Linked Apps. . By using X-rays, they create two-dimensional images of the breast to spot suspicious tissue that may be cancerous. American Imaging Management (AIM) was selected as a vendor in part due to their track record of creating cost savings while reducing the unnecessary administrative burden on physician offices. Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). 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%. Health Focus: Breast Cancer Prevention | Blue Cross Blue Shield of Alabama Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested. 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. The cost estimate changed prior to your care. Inscribirse ahora! The protection of your privacy will be governed by the privacy policy of that site. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Here's how to interpret your BMI: Below 18.5: underweight. Dynamic contrast material-enhanced MRI may be used to monitor response of a tumor to neoadjuvant chemotherapy used to shrink the tumor before surgery. Your dashboard may experience future loading problems if not resolved. Screening can help find breast cancer early, when it is easier to treat. If physicians have questions about the Blue Cross NC diagnostic imaging management program, they should contact their local Network Management representatives. Screening and Diagnostic Mammography & 3D Tomosynthesis - Horizon Blue Plus, your medical plan covers 100% of the costs for preventive health services when care is provided through network providers. One option is Adobe Reader which has a built-in screen reader. Colorectal Cancer . Privacy Policy Forgot User ID? No coverage for routine physical examinations. Which health plans does the program apply to? Blue Cross NC has partnered with American Imaging Management, Inc. (AIM) for the management of outpatient, high-tech diagnostic imaging services. 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. Coverage Information | Blue Cross and Blue Shield of Texas Life-Saving: Cancer detection is the key to early treatment and better outcomes. What clinical criteria does AIM use to determine if a procedure will be approved? Make sure to get all the screenings and vaccines recommended for your age and gender. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. Most PDF readers are a free download. Another Reason to Get Moving: Exercise Can Help Lower Cancer Risk. Click on a service to see any limits or exclusions. Accessibility Blue Cross and Blue Shield Federal Employee Program Tests that do not meet national clinical guidelines will not be approved. Breast cancer is the most common type of cancer in women. The policies were effective for diagnostic imaging services performed on or after February 15, 2007 for Blue Cross NC commercial plans. If there is a medical reason you cannot use a generic statin, your doctor should review this. hb```,z@ (Mf`X b`Fe~F9}mS6.awa`\V_RQ g-e0 BSC6.07 Digital Breast Tomosynthesis - Blue Shield of California Has Blue Cross NC considered disallowing self-referrals? Some providers charge more, and some offer an uninsured discount. Enroll Now. Privacy Policy listed below will be covered by your plan. For more information, view our privacy policy. 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 . Scenario 1: Brand Truvada, Viread, or Descovy may be made available if you are clinically unable to use generic Truvada. Learn more about our non-discrimination policy and no-cost services available to you. According to the American Cancer Society, our state lags behind much of the nation in mammography screenings. You should call the number on the back of your member ID card for more information before you schedule one. Blue Medicare HMO and Blue Medicare PPO (as of September 1, 2010). The protection of your privacy will be governed by the privacy policy of that site. Obesity screenings. Cost estimates are based only on the coverage you have with us. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the . Did you know preventive health measures and screenings can prevent 85% of illness and disease, and are covered at no cost for many plans? Data shows that roughly 30-40% of imaging exams are considered clinically inappropriate or noncontributory. To view this file, you may need to install a PDF reader program. 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.