blue cross blue shield mammogram coverage

Technical Information You can also visit our Mental Health Resource . All premiums listed represent coverage for dependents up to age 26. 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. . 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. Bacteriuria screening for pregnant women. Health coverage is offered by Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. Access Your Payment Options. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. Others have a false sense of . It's important for adult women to have annual wellness exams after the age of 21. No lump, no cancer. Annually about 220,000 women are diagnosed with breast cancer. Side-to-side and top-to-bottom images . Issuance of prior approval is not a guarantee of payment. Provided by an in-network doctor or facility (urgent care facility, outpatient clinic or ambulatory surgery center), Filed by your doctor as a preventive care visit, Identified as preventive care under the Affordable Care Act (ACA), In women age 2129 with cervial cytology (pap test) every 3 years, A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. 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. Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested. should confirm that a prior approval number has been issued. Site Map The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue Shield of Alabama. 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. Help Center. Technical Information Heres everything you need to know about it. Are you going to reimburse providers for the savings Blue Cross NC will incur? Fargo (Headquarters) All Rights Reserved. 0 Currently, under the Patient Protection and Affordable Care Act Annual Checkups and certain preventive . About 10% of patients who receive routine mammograms get called back for another look. Cancer screenings like colonoscopies and mammograms. 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. How do 3D Mammograms Differ From Standard Ones? Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. You should call the number on the back of your member ID card for more information before you schedule one. What imaging procedures require prior plan approval? A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. 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. 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). (EOB) from Blue Shield of California to notify you that your claim has been processed. 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 Medicare PPO plans): Prior approval is not required when these procedures are performed in an emergency room, hospital (related to an inpatient or observation stay), urgent care center or ambulatory surgical center. Council and Blue Cross and Blue Shield of . We use cookies on this website to give you the best experience and measure website usage. Screening for Cervical Cancer 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 check your coverage with your insurance provider before your appointment with us. Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : mammograms. Most Florida Blue plans cover annual screening mammograms for women age 40 and older for as low as a $0 copay. Has Blue Cross NC considered disallowing self-referrals? Life-Saving: Cancer detection is the key to early treatment and better outcomes. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. Women ages 40 and older can receive a mammogram (four views) each calendar year. No. 122 0 obj <>/Filter/FlateDecode/ID[<13345823F9F84C49978F51E9E4B0DEB3><85AA0C7815CFFF46BE97C496C3A4895B>]/Index[104 37]/Info 103 0 R/Length 89/Prev 75360/Root 105 0 R/Size 141/Type/XRef/W[1 2 1]>>stream The protection of your privacy will be governed by the privacy policy of that site. Breast cancer mammography screenings for women over age 40; Colorectal cancer screening for adults over age 45; . Provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions. For most women, mammogram technology is still considered the best way to detect breast abnormalities and cancers early. Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. recipe is no mess, no fuss and all flavor. Covered: Getting screened wont break the bank. %PDF-1.5 % Health Insurance Tax Information; Transparency in Coverage; Mental Health Parity; Teledentistry Services Covered; . What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Heres a deeper dive on the potential benefits and risks of a 3D mammogram. There are many easy-to-use BMI calculators online, such as this example from the Centers for Disease Control and Prevention.*. For this reason, 2D mammograms can sometimes produce inaccurate findings. What process is in place for unfavorable determinations? Approve annually starting at age 30; Individuals not yet tested for BRCA gene, but with known BRCA mutation in first degree relative. 18.5 - 24.9: healthy weight. When it's diagnostic: If your doctor . One of the goals of this program is to help contain health care costs. Mammograms use very small doses of radiation and the risk of harm is very low. One its drawbacks is breast tissue can overlap during compression. Olvido su contrasea? The U.S. Preventive Services Task Force currently recognizes both 2D and 3D mammography as equally acceptable screening methods. Which health plans does the program apply to? Copyright 2023 Health Care Service Corporation. Olvido su contrasea? Thanks in part to preventive screenings, there are approximately 2.8 million breast cancer survivors in the U.S. as of 2016. 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. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. About one in every seven or eight women gets it in her lifetime. 4510 13th Ave. S. Find your ideal accommodation from hundreds of great deals and save with www.trivago.com Talk to your doctor to find out which of these you should have based on your health. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . Learn more aboutmammogram screeningsin this video. Healthy tissue may appear suspicious and cancerous tissue can be masked. 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 . Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . Take advantage of preventive care and stop problems before they get serious. 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. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. However, some services like 3D imaging or ultrasounds may not be fully covered the same way. 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). All rights reserved. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. Blue Cross and Blue Plus plans cover these eligible preventive services for women ages 12-64, with no member cost sharing when obtained at the in-network level*: Alcohol and substance misuse counseling. All women need to be informed by their healthcare provider about the best screening options for them. 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. CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval. Yes. - Ebonie from Chicago, IL [Humana HMO] "I used to have Blue Cross Blue Shield and we didn't have a copay for normal mammograms but even then, I still paid $1700 because the no-cost mammogram lead to ultrasound, another mammogram, and an MRI. 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. When it's preventive: You get a mammogram to check for breast cancer. Mammograms: Women age 40 and older should have a screening mammogram every year and should continue to do so for as long as they are in good 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. This information is a reference tool and does not guarantee payment of any claims. If something is found in a preventive screening mammogram, the screening is still at no cost to the member. The diagnostic imaging management program guidelines are based on the most up-to-date recommendations of physician organizations such as the American College of Radiology and the American College of Cardiology. Screening for depression in postpartum women. In addition, some sites may require you to agree to their terms of use and privacy policy. Coverage that is supplemental to Medicare but with no member cost Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.