Routine mammograms are covered by the state health plan at no cost to you. You should call the number on the back of your member ID card for more information before you schedule one. http://www.breastcancer.org/symptoms/understand_bc/statistics Breast tomosynthesis is an . https://www.anthem.com/health-insurance/health-care-reform-resources/reform-law-detail/more-womens-preventive-care-covered?reformlaw=l1019 Some state or federal mandates [e.g., Federal Employee Program (FEP)] prohibits plans from Generally, practicing consistently with national evidence-based guidelines is expected to reduce errors and liability. TheU.S. Preventive Services Task Forcerecommends that women between the ages of 50 and 74 get a mammogram every two years. All women 40 or older should ask their doctor about when to start getting mammograms and how often theyre needed. 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. Focusing on the right test at the right time for the right patient could save time and mone and increase productivity. To be covered with no out-of-pocket costs, the service must be: Special information for employees of religious organizations. Blue Cross NC will be the fourth company to implement a diagnostic imaging program in North Carolina. 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. Breast cancer risk factors include: Check with your doctor if you have questions about mammograms or other breast cancer screenings. Use the subsidy calculator to enter your own . Mammograms use very small doses of radiation and the risk of harm is very low. This information is a reference tool and does not guarantee payment of any claims. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Why did Blue Cross NC implement a diagnostic imaging management program? If you get benefits from your employer, you may also have these benefits. Sydney Care is offered through an arrangement with Carelon Digital Platforms, Inc. Sydney Health and Sydney Care are service marks of Carelon Digital Platforms, Inc., 2023, http://www.breastcancer.org/symptoms/understand_bc/statistics, https://www.anthem.com/health-insurance/health-care-reform-resources/reform-law-detail/more-womens-preventive-care-covered?reformlaw=l1019, http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. Breast cancer mammography screenings for women over age 40; Colorectal cancer screening for adults over age 45; . The AIM physician reviewer may contact the ordering physician to discuss the case in greater detail within two (2) business days of receipt of the request. Do practicing North Carolina physicians have input into the program? According to the American Cancer Society, our state lags behind much of the nation in mammography screenings. Select Your Gender. For example, at the Kapiolani Medical Center [ 1] in Aiea, Hawaii, where the full . Your doctor can help you choose a facility thats convenient for you. 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). . Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. 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. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. The U.S. Preventive Services Task Force currently recognizes both 2D and 3D mammography as equally acceptable screening methods. Most PDF readers are a free download. Here's a deeper dive on the potential benefits and risks of a 3D mammogram. If there is a medical reason you cannot use a generic statin, your doctor should review this. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . Mammograms are for older women. Through a preventive exam and routine health screenings, your doctor can determine your current health status and detect early warning signs of more serious, costly problems. A Pap test every 3 years or. To capture them, the breast is pulled away from the body, compressed and held between two glass plates. During this visit, your doctor examines your overall health. Limited to a 90 day supply each for two cessation efforts. It's important to note that your provider has the right to code and bill services according to his or her viewpoint. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. Its important for adult women to have annual wellness exams after the age of 21. 25 - 29.9: overweight. How long is an authorization of a diagnostic imaging procedure valid? 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. Screening for depression in postpartum women. The age and frequency listed below are general recommendations. Check out the changes and updates to our plan in 2023. During this visit, your doctor examines your overall health. Others have a false sense of . What is a Religious Organization:A religious organization refers to all employer groups defined under federal law that may limit or not cover contraceptive services due to the type of organization or that have a religious objection to these services. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. Yes, they will cover annual mammograms if they are suitable to age. Healthy tissue may appear suspicious and cancerous tissue can be masked. Blue Cross and Blue Shield of Illinois . This new site may be offered by a vendor or an independent third party. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . Screening mammograms every 12 months if you are a woman age 40 or older. File is in portable document format (PDF). Check out the changes and updates to our plan in 2023. But Humana, which I have now, is even worse because I have a $50 copay just for screening." 3. The American Cancer Society recommends women ages 40 to 54 get annual mammograms, and women 55 and older get screenings every two years. You can also visit our Mental Health Resource . 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. Cat-scan technology exposes patients to more radiation than an X-rays. Take advantage of preventive care and stop problems before they get serious. For this reason, 2D mammograms can sometimes produce inaccurate findings. Preventive Care. Bacteriuria screening for pregnant women. Service & Support; FAQs; Find an Event; Public Service Recognition; About Us; 1 results found for search term : mammograms. Inscribirse ahora! Your browser is not supported. 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. Currently, about 12% of women will develop breast cancer at some point in their lifetime. Scroll down to see some common services that may or may not be covered during a preventive care visit. When it's preventive: You get a mammogram to check for breast cancer. Your member ID card is your key to using your medical plan benefits. Currently, under the Patient Protection and Affordable Care Act Annual Checkups and certain preventive . BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. $100 outpatient benefits. 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. Annual physical exams and other preventive services are free when you use a Preferred . 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. hrHPV test only every 5 years. For more information, view our privacy policy. Copyright 2023 Health Care Service Corporation. 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 . We use cookies on this website to give you the best experience and measure website usage. hbbd``b` Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room. Approve annually starting at age 30; Individuals not yet tested for BRCA gene, but with known BRCA mutation in first degree relative.
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blue cross blue shield mammogram coverage