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. (EOB) from Blue Shield of California to notify you that your claim has been processed. The goal of the Blue Cross NC Diagnostic Imaging Program is to improve affordability for Blue Cross NC members. Doses, recommended ages and recommended populations vary. Not all participating DME vendors carry breast pumps. "To put it in perspective, the dose of radiation is lower than that of a chest x . Blue Cross NC is very aware of the concerns about self-referral. Your doctor will collect a sample of cells from your cervix to test for any abnormal or precancerous cells. No lump, no cancer. . Ordering physicians may also contact the AIM physician reviewer at any time during the authorization process. There are many easy-to-use BMI calculators online, such as this example from the Centers for Disease Control and Prevention.*. 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. Check out the changes and updates to our plan in 2023. 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. Usage Agreement Others have a false sense of . Accessibility Blue Cross and Blue Shield Service Benefit Plan brochures, https://www.mayoclinic.org/tests-procedures/brca-gene-test/about/pac-20384815. If eligible, you must receive genetic counseling and evaluation services before you receive preventive BRCA testing. No coverage for routine physical examinations. "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 . Site Map 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. listed below will be covered by your plan. 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. 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. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Your dashboard may experience future loading problems if not resolved. Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . The scans take detailed X-ray images from many angles. Mammogram screening $0 Once per year Nutrition therapy services $0 Ongoing if high risk In addition, some sites may require you to agree to their terms of use and privacy policy. About 10% of patients who receive routine mammograms get called back for another look. Dynamic contrast material-enhanced MRI may be used to monitor response of a tumor to neoadjuvant chemotherapy used to shrink the tumor before surgery. The protection of your privacy will be governed by the privacy policy of that site. Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. Technical Information For women age 30-65. 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. (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. Provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions. There has been an error with your submission. Page 2 of 33. time of service to determine coverage or non -coverage of these services as it applies to an individual member. Coverage is subject to the specific terms of the member's benefit plan. The age and frequency listed below are general recommendations. Health plans are offered by Blue Shield of California. Blue Shield of California is an independent member of the Blue Shield Association. Non-Discrimination Statement and Foreign language Access. Diagnostic mammograms more frequently than once a year, if medically necessary. Some sites may require you to agree to their terms of use and privacy policy. No lump, no cancer. Council and Blue Cross and Blue Shield of . 2020. . A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. This screening is no cost to you. Please review the terms of use and privacy policies of the new site you will be visiting. Healthy tissue may appear suspicious and cancerous tissue can be masked. Issuance of prior approval is not a guarantee of payment. Do practicing North Carolina physicians have input into the program? Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Regular mammograms improve survival rates by 35% in women over 50. Is the program focused mainly on saving money? BCBSIL Provider Manual June 2020 2 . 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. Talking with your healthcare provider about the . If there is a medical reason you cannot use a generic statin, your doctor should review this. Screening mammograms every 12 months if you are a woman age 40 or older. 140 0 obj <>stream Compare the prices of 26634 hotels in Ho Chi Minh City, Vietnam. During this visit, your doctor examines your overall health. Make sure to get all the screenings and vaccines recommended for your age and gender. You must also receive prior approval from us. 4510 13th Ave. S. When it's preventive: You get a mammogram to check for breast cancer. Mammograms are one of the best ways to find it early. Pays cash if you're treated for cancer. Talk to your doctor to find out which of these you should have based on your health. And that means no copays, coinsurance or payment toward your deductible. Its important for adult women to have annual wellness exams after the age of 21. The following preventive services and immunizations do not apply to all health plans administered or insured by Blue Cross and Blue Shield of Alabama. Providers can find complete instructions on how to request prior approval outlined on the diagnostic imaging procedures page. January 25, 2016. We can send you an email with information on our health care plans. It is important to note that these services are free only when delivered by a doctor or other . Tests that do not meet national clinical guidelines will not be approved. Not all employer groups participate in the diagnostic imaging management program. 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. Anesthesia and pathology from polyps found during a screening colonoscopy is covered at 100%. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. 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. Blue Cross Blue Shield of Massachusetts also offers insurance, pharmacy coverage, and Medicare Plans for seniors; life and disability insurance through Indigo Insurance Services (a wholly owned subsidiary); and insurance for individuals aged 18-26 years. 18.5 - 24.9: healthy weight. Your doctor may order a colonoscopy more frequently than every 10 years. Provider consultation prior to the colonoscopy procedure is covered at 100%. What places or settings of treatment are affected? As a result, 3D mammograms lower the number of false alarms. Olvido su contrasea? Blue Cross NC data confirm there is significant opportunity to contain health care costs and reduce member exposure to radiation by eliminating scans that are clinically inappropriate or noncontributory to the care. Anemia screening for pregnant women. Yes. Description: Screening for cervical cancer. Achieving this requires that we reduce the number of imaging examinations that do not add diagnostic value for members. Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. Fargo, N.D., 58121. No coverage for oral contraceptive devices. Your doctor will advise on recommended immunizations that can protect against a number of serious diseases. Will this program impact members' ability to receive the tests they need? Standard 2D mammograms take two pictures of the breast. Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room. For more information, view our privacy policy. Mental Health Services. endstream endobj startxref Colorectal Cancer . $X^ "@\(k'h,@7HI?NH2012|Igl ` |> Additional mammograms may require cost sharing. We apologize for any inconvenience. See your doctor andrefer to the CDCs posted schedule of immunizations for more information. 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. Health Plans for Individuals and Families, Get a Quote for Individual and Family Plans, Non-Discrimination Policy and Accessibility Services. Here's how to interpret your BMI: Below 18.5: underweight. 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. File is in portable document format (PDF). But Humana, which I have now, is even worse because I have a $50 copay just for screening." 3. Olvido su contrasea? 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) . Inscribirse ahora! 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. For example, women who have a family history of breast, cervical or ovarian cancer can be tested for the BRCA1 or BRCA2 genes. Breast Cancer and Early Detection: What Women Need to Know. It happens in both men and women, but breast cancer in men is not common. Mammograms are a key component of a womens preventative care. Generally, practicing consistently with national evidence-based guidelines is expected to reduce errors and liability. 2 The HPV vaccine (Gardasil) is covered to age 45 per the Food and Drug Administration (FDA) guidelines. By slowing this growth and containing costs through a proactive diagnostic imaging management program, we anticipate costs savings over time. Limited to a 90 day supply each for two cessation efforts. In fact, we rank 32nd out of 50 states. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Women who get a 3D mammogram may also get a traditional 2D mammogram, exposing them to higher amounts of radiation. 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. Preventive Care. Screening for depression in postpartum women. 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. To be covered with no out-of-pocket costs, the service must be: Special information for employees of religious organizations. If so, it should not impact the ability of members to receive these tests. Frequency: In women age 21-29 with cervial cytology (pap test) every 3 years. Use this tool to create personalized recommendations for your . We apologize for any inconvenience. Cancer screenings like colonoscopies and mammograms. Side-to-side and top-to-bottom images . Combined together, the X-rays create a three-dimensional picture of each breast. Mammograms are one of the best ways to find it early. Clinical breast exam: Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a regular exam by a health professional, at least every three years. 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). Heres everything you need to know about it. They can help detect breast cancer up to three years before it can be felt. $300 inpatient benefits. 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. These benefits are available for members of non-grandfathered individual health insurance plans. Who can physicians call if they have questions? Please send us your question so a licensed agent can contact you. Ordering physicians for Blue Cross NC members must obtain prior approval prior to scheduling an imaging exam for outpatient diagnostic, non-emergent services. Should a member request Originally published 11/16/2015; Revised 2019, 2022, Get News & Updates Directly To Your Inbox. Telephonic counseling available by calling QuitlineNC at 844-8NCQUIT. We have an obligation to our members to provide quality care at an affordable price. 3D mammograms may be covered by your health plan. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. . The following are the recommended vaccines for women that are covered with no out of pocket cost. Evaluation of suspected breast cancer when other imaging examinations, such as ultrasound and mammography, and physical examination are inconclusive for the presence of breast cancer, and biopsy could not be performed (e.g. Heres a deeper dive on the potential benefits and risks of a 3D mammogram. If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this. Routine health checkups. Since these are preventive care visits, there is no cost when seeing a Preferred provider for both Basic and Standard Option members. Please check your coverage with your insurance provider before your appointment with us. Summary of Arkansas Blue Cross Blue Shield and Health Advantage Coverage Polices. You should call the number on the back of your member ID card for more information before you schedule one. The cost of many screenings and checkups is covered at 100% with no out of pocket costs for you and those on your plan.
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