Prior approval is required by all facilities or settings that offer outpatient, nonemergency diagnostic imaging services. Among the preventive health benefits for our members, Regence covers mammography at 100 percent for women. Bronze Standard - Individual & Family Health Plans 2021 - BCBSWNY , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Inscribirse ahora! Estimate Costs: Colonoscopy, Mammogram, MRI & More | BCBSNE - NebraskaBlue Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. Breast Screening Benefit "Diagnostic mammogram" means a mammogram obtained using diagnostic mammography . http://www.breastcancer.org/symptoms/understand_bc/statistics Breast Cancer Mammography Screening Age 35-39 . "Screening" means checking a woman's breasts for cancer before there are signs or symptoms of the disease present. Access Your Payment Options. Non-Discrimination Statement and Foreign language Access. Women ages 35-39 can receive one baseline mammogram (four views). Mammograms use very small doses of radiation and the risk of harm is very low. So why do so many women put off their mammograms? For this reason, 2D mammograms can sometimes produce inaccurate findings. This new site may be offered by a vendor or an independent third party. What information is required to request prior approval? listed below will be covered by your plan. During this visit, your doctor examines your overall health. 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. Diagnostic mammograms more frequently than once a year, if medically necessary. 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). However, sometimes tests are ordered and are not clinically appropriate. Research shows 3D mammography (breast tomosynthesis) can detect breast cancer 28% more accurately than standard mammograms. If you have a higher risk for breast cancer, talk to your doctor about screening, no matter how old you are. . Tissue doesnt overlap. Forgot Password? Please utilize the checklist below as a guideline to ensure you have all the necessary information before requesting prior approval: For complex cases, more information may be necessary, including: The diagnostic imaging management process is based upon AIM clinical practice guidelines, developed from consensus opinion in medical practice and integration of medical information from multiple sources, including: The prior approval number will be valid for 30 days from the date issued - not the date of service requested. Breast Cancer | Blue Cross and Blue Shield of Texas - BCBSTX 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 . 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. Pays in addition to your other coverages. BCBSIL Provider Manual June 2020 2 . In addition, some sites may require you to agree to their terms of use and privacy policy. To view this file, you may need to install a PDF reader program. Breast cancer mammography screenings for women over age 40; Colorectal cancer screening for adults over age 45; . Here's a deeper dive on the potential benefits and risks of a 3D mammogram. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the . 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. Understanding your preventive care benefits - Blue Shield of California Out of network billing can lead to unexpected charges. Check out the changes and updates to our plan in 2023. All women 40 or older should ask their doctor about when to start getting mammograms and how often theyre needed. For women age 30-65. Place of service exclusion: Sterilization coverage applies to all places of service, with the exception of the Emergency Room. For women with a history of gestational diabetes who are not currently pregnant and who have not previously been diagnosed with type 2 diabetes. Are you going to reimburse providers for the savings Blue Cross NC will incur? 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. 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. 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. Health Focus: Breast Cancer Prevention | Blue Cross Blue Shield of Alabama These benefits are currently in effect unless otherwise noted. Learn more about our non-discrimination policy and no-cost services available to you. Diagnostic Imaging FAQs | Imaging Procedures | Blue Cross Blue Shield Your member ID card is your key to using your medical plan benefits. If you get benefits from your employer, you may also have these benefits. 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. When it's preventive: You get a mammogram to check for breast cancer. Accessibility Inconclusive screening mammogram due to breast characteristics limiting the sensitivity of mammography . January 25, 2016. File is in portable document format (PDF). No lump, no cancer. Does this prior approval impact Blue Medicare HMO and Blue Medicare PPO? Scroll down to see some common services that may or may not be covered during a preventive care visit. If you had a polyps removed during a previous preventive screening colonoscopy, future colonoscopies will be covered but may not be considered preventive so you may have out of pocket costs. Your browser is not supported. to expand insurance coverage for diagnostic mammograms. Preventive Service Benefits - Bcbsal.org Breast MRI | BCBSND CT, CTA MRI, MRA, PET and echocardiography scans related to an emergency room visit, hospital stay or outpatient observation do not require prior approval. Preventive Health Care Plans & Guidelines | Anthem.com The site may also contain non-Medicare related information. During this visit, your doctor examines your overall health. Regence supports women's preventive breast health. Here's how to interpret your BMI: Below 18.5: underweight. As an example, women get regular mammograms at no cost to them as a preventive screening. Fraud and Abuse 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. Compare the prices of 26634 hotels in Ho Chi Minh City, Vietnam. Frequently Asked Questions: Mammograms - Blue Cross Blue Shield of Combined together, the X-rays create a three-dimensional picture of each breast. You are only exposed to a small amount of radiation during a mammogram, and studies show that the benefits of mammograms outweigh any risks. However, about 72% of women with BRCA1 and about 69% of women with BRCA2 will develop breast cancer by the age of 80. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. Assessing Your Risk Please send us your question so a licensed agent can contact you. Privacy Policy What imaging procedures require prior plan approval? Health plans are offered by Blue Shield of California. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com.

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