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If physicians have questions about the Blue Cross NC diagnostic imaging management program, they should contact their local Network Management representatives. One of the goals of this program is to help contain health care costs. Focusing on the right test at the right time for the right patient could save time and mone and increase productivity. Some sites may require you to agree to their terms of use and privacy policy. Cat-scan technology exposes patients to more radiation than an X-rays. One option is Adobe Reader which has a built-in screen reader. This can get confusing, so call your health plan before you go. Why did Blue Cross NC implement a diagnostic imaging management program? - 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. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. AIM has a track record of successful experience working with many providers and other Blue Cross and Blue Shield plans across the country. HMO coverage is offered by Health Options, Inc. DBA Florida Blue HMO. 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. Disponible nicamente en ingls. . "To put it in perspective, the dose of radiation is lower than that of a chest x . 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? Enroll Now. BRCA is an abbreviation for the BReast CAncer gene, which is an inherited trait. 104 0 obj <> endobj The American Cancer Society recommends women ages 40 to 54 get annual mammograms, and women 55 and older get screenings every two years. to expand insurance coverage for diagnostic mammograms. Forgot User ID? It may also be used to depict residual disease after neoadjuvant chemotherapy. The cost estimate changed prior to your care. 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.) If so, it should not impact the ability of members to receive these tests. Learn more about our non-discrimination policy and no-cost services available to you. 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. There are many easy-to-use BMI calculators online, such as this example from the Centers for Disease Control and Prevention.*. mammogram for women between ages 35-39. During this visit, your doctor examines your overall health. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Find an in-network doctor for preventive care. Women ages 40 and older can receive a mammogram (four views) each calendar year. If you have questions about coverage for preventive services, . . So why do so many women put off their mammograms? Routine mammograms are covered by the state health plan at no cost to you. Necesita su ID de usuario? *Applicable Wellness Screenings: $50 benefit paid one time per year, per insured (age 18 and over) for breast ultrasound, breast MRI, mammograms, CA 15-3 . Forgot Password? SOURCES: Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services, medications and OTC nicotine replacement therapy (NRT), refer to the CDCs posted schedule of immunizations for more information. This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. A mammogram uses an X-ray to examine the breast tissue and can detect changes before you can feel them. A Pap test every 3 years or. Here's a deeper dive on the potential benefits and risks of a 3D mammogram. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Blue Cross and Blue Shield of Illinois . If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this. %%EOF You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. You have coverage from another insurance plan in addition to your Blue Cross and Blue Shield of Nebraska coverage. Only ordering physicians can obtain a prior plan approval number. Please review the terms of use and privacy policies of the new site you will be visiting. Additionally, the increased use of some high technology imaging procedures creates patient safety concerns from radiation exposure. The scans take detailed X-ray images from many angles. For women with a history of gestational diabetes who are not currently pregnant and who have not previously been diagnosed with type 2 diabetes. You should get screenings every one or two years, depending on your doctor's advice. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. For this reason, 2D mammograms can sometimes produce inaccurate findings. Starting June 1, 2022, this follow up colonoscopy will be covered at 100%. Most Florida Blue plans cover annual screening mammograms for women age 40 and older for as low as a $0 copay. The program is expected to assist Blue Cross NC in improving affordability for our members. Who can physicians call if they have questions? 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. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. By slowing this growth and containing costs through a proactive diagnostic imaging management program, we anticipate costs savings over time. There is an appeals process in place for unfavorable determinations. If there is a medical reason you cannot use a generic statin, your doctor should review this. Issuance of prior approval is not a guarantee of payment. As a result, we believe that Blue Cross NC is taking an important step for patient safety and in managing increased costs by implementing a diagnostic imaging managing program. . These benefits are currently in effect unless otherwise noted. In addition, some sites may require you to agree to their terms of use and privacy policy. 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. For most women, mammogram technology is still considered the best way to detect breast abnormalities and cancers early. Are you going to reimburse providers for the savings Blue Cross NC will incur? Understand the difference between preventive and diagnostic. Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested. Additional mammograms may require cost sharing. Blue Cross Blue Shield Global Core gives Blue Cross and Blue Shield of Vermont members access to their health care benefits wherever they go - across the country and around the world. Examples of these services include: Initial evaluation. $X^ "@\(k'h,@7HI?NH2012|Igl ` |> You are viewing estimated values for an individual. Currently, about 12% of women will develop breast cancer at some point in their lifetime. Dynamic contrast material-enhanced MRI may be used to monitor response of a tumor to neoadjuvant chemotherapy used to shrink the tumor before surgery. Others have a false sense of . There are also additional guidelines if you're pregnant. If something is found in a preventive screening mammogram, the screening is still at no cost to the member. 140 0 obj <>stream By Regence. Copyright 2023 Health Care Service Corporation. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. Your doctor will help you decide what schedule makes the most sense for you. 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. To capture them, the breast is pulled away from the body, compressed and held between two glass plates. Easy: Keeping up with your screenings is an important task, even in your busy life. Ordering physicians may also contact the AIM physician reviewer at any time during the authorization process. Use this tool to create personalized recommendations for your . 2023 Blue Cross Blue Shield of North Dakota, Please wait while your form is being submitted, Directory Validation Instructions (No Surprises Act), Recredentialing & Credentialing Applications. Approve annually starting at age 30; Individuals not yet tested for BRCA gene, but with known BRCA mutation in first degree relative. 30 and above: obese. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the . How should providers request prior approval? About 10% of patients who receive routine mammograms get called back for another look. Women ages 40 and older can receive a mammogram (four views) each calendar year. Additional Screenings for High-Risk Women Mammograms are one of the best ways to find it early. Yes. 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. Breast Cancer and Early Detection: What Women Need to Know. The age and frequency listed below are general recommendations. No lump, no cancer. If your Summary of Benefits section of your Benefit Booklet contains PREVENTIVE CARE covered under federal law, then you have these benefits at no charge IN-NETWORK. If eligible, you must receive genetic counseling and evaluation services before you receive preventive BRCA testing. Out of network billing can lead to unexpected charges. Most PDF readers are a free download. Yes, they will cover annual mammograms if they are suitable to age. BlueCross BlueShield of South Carolina. But Humana, which I have now, is even worse because I have a $50 copay just for screening." 3. By continuing to use this website, you consent to these cookies. Not all employer groups participate in the diagnostic imaging management program. By continuing to use this website, you consent to these cookies. 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. Approve annually starting at age 30; Individuals with known BRCA mutation. Preventive Care Plans & Guidelines. Tissue doesnt overlap. During this visit, your doctor examines your overall health. $300 inpatient benefits. Annual physical exams and other preventive services are free when you use a Preferred provider. Inscribirse ahora! To learn if your patient's plan requires prior approval for these services, please reference the diagnostic imaging procedures page.