Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Your doctor can help you choose a facility thats convenient for you. 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. to expand insurance coverage for diagnostic mammograms. Starting June 1, 2022, this follow up colonoscopy will be covered at 100%. 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. Your browser is not supported. All premiums listed represent coverage for dependents up to age 26. Coverage that is supplemental to Medicare but with no member cost 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. listed below will be covered by your plan. If you discuss new medical concerns or a current illness, the entire visit may be considered a medical treatment visit and would not be covered as preventive care. 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. 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%. Of the 4 million women age 40 to 65 in Texas, 2.6 million . Achieving this requires that we reduce the number of imaging examinations that do not add diagnostic value for members. Please review the terms of use and privacy policies of the new site you will be visiting. Should a member request . You have coverage from another insurance plan in addition to your Blue Cross and Blue Shield of Nebraska coverage. If something is found in a preventive screening mammogram, the screening is still at no cost to the member. This screening is no cost to you. Mammograms are for older women. Your dashboard may experience future loading problems if not resolved. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. A Pap test every 3 years or. 2020. . If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this. hrHPV test only every 5 years. Screening for Cervical Cancer By Regence. Women ages 40 and older can receive a mammogram (four views) each calendar year. The site may also contain non-Medicare related information. "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 . Returning Shopper? As an example, women get regular mammograms at no cost to them as a preventive screening. 140 0 obj
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Another Reason to Get Moving: Exercise Can Help Lower Cancer Risk. 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. 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. The USPSTF recommends biennial screening mammography for . Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. 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. Provider consultation prior to the colonoscopy procedure is covered at 100%. 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. As always, be sure to check your specific plan coverage and see an in-network provider. No family history, no risk. Some state or federal mandates [e.g., Federal Employee Program (FEP)] prohibits plans from Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. If you have an HMO or POS plan, there are some additional services you'll need approval for. Make sure to get all the screenings and vaccines recommended for your age and gender. 1 If you have gotten one dose of Zostavax vaccine for shingles, you should also get the two doses of Shingrix vaccine. The remaining 40% are out-of-pocket costs. Screening can help find breast cancer early, when it is easier to treat. Mammograms arent as painful as you think you may feel a little pressure but it only lasts a few seconds. Insurance. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. Servicing providers (hospitals, freestanding imaging centers, etc.) Women between the ages of 40 and 49 should talk to their doctor about when they should start getting mammograms. 30 and above: obese. 0
The site may also contain non-Medicare related information. We recognize that any requirements for prior plan approval for procedures place an administrative burden on physicians, and we continually evaluate such programs to assure that they deliver on promised savings to members while attempting to minimize the impact on provider offices. Learn more about our other insurance plans and Medicare plans, or contact a sales . One of the goals of this program is to help contain health care costs. Medications covered at 100%: Lovastatin (20 or 40 mg) or Pravastatin (10, 20, 40 or 80 mg). Am I eligible for these benefits at 100%? Technical Information Your member ID card is your key to using your medical plan benefits. In fact, we rank 32nd out of 50 states. 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. Here's how to interpret your BMI: Below 18.5: underweight. Access Your Payment Options. Side-to-side and top-to-bottom images . 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. January 25, 2016. Mammograms are for older women. What clinical criteria does AIM use to determine if a procedure will be approved? 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. Select a Region: Please Select One DVEST1 DV9ST1 DV8ST1 DV5ST1 DV4ST1 DV1ST1 DVPST1 DVOST1 DVMST1 DVJST1 DVHST1 DVGST1 DVFST1 DVEST1 DVDST1 DVCST1 LOEST1 This new site may be offered by a vendor or an independent third party. Blue Cross NC has partnered with American Imaging Management, Inc. (AIM) for the management of outpatient, high-tech diagnostic imaging services. Its important for adult women to have annual wellness exams after the age of 21. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . Copy. Please send us your question so a licensed agent can contact you. Breast cancer is the most common type of cancer in women. Best Answer. Serving Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. By slowing this growth and containing costs through a proactive diagnostic imaging management program, we anticipate costs savings over time. 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 For this reason, 2D mammograms can sometimes produce inaccurate findings. 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. Who reviews requests for diagnostic imaging prior approval? AIM has a track record of successful experience working with many providers and other Blue Cross and Blue Shield plans across the country. 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.) Standard 2D mammograms take two pictures of the breast. Council and Blue Cross and Blue Shield of . One option is Adobe Reader which has a built-in reader. 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. Usage Agreement Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. No prescription medication or NRT limit when received via pharmacy benefit, Tetanus-Diphtheria/Tetanus-Diphtheria Acellular Pertussis (Tdap). Privacy Policy Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Thanks in part to preventive screenings, there are approximately 2.8 million breast cancer survivors in the U.S. as of 2016. Side-to-side and top-to-bottom images are made. During your visit, your doctor will perform a clinical breast exam. Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : mammograms. Genetic counseling and evaluation can help determine if youve inherited a BRCA mutation. They can help detect breast cancer up to three years before it can be felt. Barium enema is a covered service but not at 100% so you may have out of pocket costs. The cost estimate changed prior to your care. How do 3D Mammograms Differ From Standard Ones? http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. We will work with the physician community through our Diagnostic Imaging Management Advisory Group to assure that there is no negative impact on the quality of patient care as a result of this initiative. Obesity screenings. Combined together, the X-rays create a three-dimensional picture of each breast. Blue Cross and Blue Shield of Illinois . (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. A follow-up study may be considered medically necessary to help evaluate an individual's progress after treatment, procedure, intervention or surgery. Issuance of prior approval is not a guarantee of payment. They'll also look for early signs of breast and cervical cancer. Psychotherapy. Still, over the past decade, there have been advances in mammogram technology. No coverage for routine physical examinations. Still, the overall benefit of 2D and 3D breast cancer screening outweigh any potential risks linked to radiation exposure. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.
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