What imaging procedures do NOT require prior approval? Should a member request To view this file, you may need to install a PDF reader program. Please send us your question so a licensed agent can contact you. Returning Shopper? We recommend receiving estimates close to . Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. 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. How does Blue Cross NC ensure that the program does not negatively impact patient care, divert physicians from the practice of medicine or compromise the patient/physician relationship? Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested. 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). 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. Connect Community - Blue Cross and Blue Shield of Illinois, Radiation treatments to the breast or chest area. State of South Carolina - Women's Wellness Mammograms use very small doses of radiation and the risk of harm is very low. NRT through QuitlineNC is available without a prescription. . No coverage for oral contraceptive devices. 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. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Accessibility Description: clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy. Privacy Policy This allows the whole breast to be seen. Regence supports women's preventive breast health | Regence No lump, no cancer. Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room. - 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. Pays in addition to your other coverages. 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. Blue Medicare HMO and Blue Medicare PPO (as of September 1, 2010). No prescription medication or NRT limit when received via pharmacy benefit, Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap). Additional Screenings for High-Risk Women 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). Diagnostic Imaging FAQs | Imaging Procedures | Blue Cross Blue Shield The cost of many screenings and checkups is covered at 100% with no out of pocket costs for you and those on your plan. 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. Technical Information mammogram for women between ages 35-39. 2021 plans will be available for purchase beginning on November 1, 2020. Heres everything you need to know about it. Insurance. About 10% of patients who receive routine mammograms get called back for another look. Internal Medical Policy Committee 11-19-2020 Annual Review-Title changed slightly, Internal Medical Policy Committee 11-23-2021 Annual Review-no changes in criteria, Internal Medical Policy Committee 11-29-2022 Annual Review-no changes in criteria. The remaining 40% are out-of-pocket costs. Routine health checkups. The site may also contain non-Medicare related information. Talking with your healthcare provider about the . (EOB) from Blue Shield of California to notify you that your claim has been processed. 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. Side-to-side and top-to-bottom images are made. 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. The site may also contain non-Medicare related information. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. 104 0 obj <> endobj 25 - 29.9: overweight. Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. Blue Cross and Blue Shield Association. Currently, about 12% of women will develop breast cancer at some point in their lifetime. BCBSIL Provider Manual June 2020 2 . Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. "To put it in perspective, the dose of radiation is lower than that of a chest x-ray," Mehta said. Site Map Register Now, Ancillary and Specialty Benefits for Employees. Preventive care includes routine well exams, screenings and immunization intended to prevent or avoid illness or other health problems. 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) . All premiums listed represent coverage for dependents up to age 26. Most basis mammogram screenings are covered by your health plan. Scroll down to see some common services that may or may not be covered during a preventive care visit. Dental, Life and Disability are offered by Florida Combined Life . 2020. . Separately billed services are not covered under preventive services and are subject to the normal benefits based on place of service, may have them as a covered benefit, but not as a preventive care benefit covered at 100%, may not have contraceptive benefits through your group medical plan, If either of these two scenarios apply to you, have your provider fill out and fax. PDF Blue Cross and Blue Shield of Illinois Provider Manual - BCBSIL Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. Provider consultation prior to the colonoscopy procedure is covered at 100%. This screening is no cost to you. Forgot User ID? New health problems discussed with your doctor during your visit, Diagnoses that need to be addressed such as high blood pressure, diabetes, skin rash, and headaches, Breast cancer mammography screenings for women over age 40, Colorectal cancer screening for adults over age 45, Cholesterol screening for adults of certain ages or at higher risk, Additional testing and follow-up procedures if abnormalities are found during mammography or colorectal cancer screenings, Request for a vitamin Dlevel check to test for bone and muscle development and function, Request for a vaccination filter test to determine acceptable amounts of vaccine antibodies in the bloodstream. http://www.breastcancer.org/symptoms/understand_bc/statistics Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. By using X-rays, they create two-dimensional images of the breast to spot suspicious tissue that may be cancerous. Some women have a higher risk of developing cancer than other women. This new site may be offered by a vendor or an independent third party. Health plans are offered by Blue Shield of California. While 3D mammograms show some promise in better health outcomes, there isnt enough research to advocate them over 2D mammograms. 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. How do 3D Mammograms Differ From Standard Ones? Find your ideal accommodation from hundreds of great deals and save with www.trivago.com Blue Cross Blue Shield of Massachusetts - Healthy Times - Preventive How should providers request prior approval? 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. Your member ID card is your key to using your medical plan benefits. However, sometimes tests are ordered and are not clinically appropriate. No. Genetic counseling and evaluation can help determine if youve inherited a BRCA mutation. The American Cancer Society recommends women ages 40 to 54 get annual mammograms, and women 55 and older get screenings every two years. So why do so many women put off their mammograms? NRT through the pharmacy benefit is available only with a prescription. %%EOF Immunizations for you and your family. Annually about 220,000 women are diagnosed with breast cancer. Servicing providers (hospitals, freestanding imaging centers, etc.) The Diagnostic Imaging Management Advisory Group is asked to help develop future phases of the diagnostic imaging program, including addressing over-utilization by self-referring physicians as necessary. Healthy tissue may appear suspicious and cancerous tissue can be masked. Examples of these services include: Initial evaluation. Regence supports women's preventive breast health. For women age 30-65. Your coverage information in the palm of your hand. Most Florida Blue plans cover annual screening mammograms for women age 40 and older for as low as a $0 copay. Find an in-network doctor for preventive care. It happens in both men and women, but breast cancer in men is not common. Still, over the past decade, there have been advances in mammogram technology. Fargo (Headquarters) We apologize for any inconvenience. Mammogram screening $0 Once per year Nutrition therapy services $0 Ongoing if high risk The goal of the diagnostic imaging program is to improve affordability of health care to Blue Cross NC members. 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. Description: Screening for cervical cancer. The program does not currently apply to FEP, Medicare Supplemental or Medicare Prescription Drug Plans. During your visit, your doctor will perform a clinical breast exam. The policies were effective for diagnostic imaging services performed on or after February 15, 2007 for Blue Cross NC commercial plans. Standard 2D mammograms take two pictures of the breast. Thanks in part to preventive screenings, there are approximately 2.8 million breast cancer survivors in the U.S. as of 2016. By Regence. If you have a positive fecal blood test (gFOBT or FIT or Cologuard) or visualization test (CT colonography or sigmoidoscopy), your doctor may order a follow up colonoscopy. Additional mammograms may require cost sharing. Provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions. 1 If you have gotten one dose of Zostavax vaccine for shingles, you should also get the two doses of Shingrix vaccine. Olvido su contrasea? Women ages 35-39 can receive one baseline mammogram (four views). The program is expected to assist Blue Cross NC in improving affordability for our members. Blue Cross NC will be the fourth company to implement a diagnostic imaging program in North Carolina. Accepted Insurances at Solis Mammography | Solis Mammography . They are regularly reviewed by physicians of appropriate specialties for consistency with the most recent medical evidence. Site Map The goal of the Blue Cross NC Diagnostic Imaging Program is to improve affordability for Blue Cross NC members. Wellness service benefits pay you money*. Typical costs: For an uninsured patient, typical full-price cost of a mammogram ranges from $80 to $120 or more, with an average of about $102, according to Blue Cross Blue Shield of North Carolina. This can get confusing, so call your health plan before you go. Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years. A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. 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. Will the diagnostic imaging management program increase the risk of malpractice? The diagnostic imaging management program impact is low; why did Blue Cross NC implement it? Non-Discrimination Statement and Foreign language Access. 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). Enrollment in the program is automatic and available to all Blue members. All women need to be informed by their healthcare provider about the best screening options for them. 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. 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. Issuance of a prior approval number is not a guarantee of payment. Blue Cross NC is very aware of the concerns about self-referral. Select Your Gender. Ho Chi Minh City Hotels | Find & compare great deals on trivago Check out the changes and updates to our plan in 2023. SOURCES: HMO Scope of Benefits Section . By continuing to use this website, you consent to these cookies. Access Your Payment Options. should confirm that a prior approval number has been issued. HMO coverage is offered by Health Options, Inc. DBA Florida Blue HMO. Some preventive care services require that you meet . 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. A high BMI can be a warning sign for potential health problems.

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