Blue Cross NC will be the fourth company to implement a diagnostic imaging program in North Carolina. Enrollment in the program is automatic and available to all Blue members. All rights reserved. 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. BCBSIL Provider Manual June 2020 2 . hb```,z@ (Mf`X b`Fe~F9}mS6.awa`\V_RQ g-e0
You must be at least 18 years old to submit a request. Coverage is subject to the specific terms of the member's benefit plan. Forgot Password? As North Dakotans, we can do better in checking for breast cancer. 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. hbbd``b` Screening for Breast Cancer Mammograms are for older women. Is the program focused mainly on saving money? By using X-rays, they create two-dimensional images of the breast to spot suspicious tissue that may be cancerous. Learn the facts, then schedule an appointment today! While radiation exposure can cause cancer, new technology helps reduce the amount of radiation exposure that comes with a mammogram. The site may also contain non-Medicare related information. Provided by an in-network doctor or facility (urgent care facility, outpatient clinic or ambulatory surgery center), Filed by your doctor as a preventive care visit, Identified as preventive care under the Affordable Care Act (ACA), In women age 2129 with cervial cytology (pap test) every 3 years, A Pap test and high-risk human papillomavirus (hrHPV) test every 5 years or. 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 an abbreviation for Blue Cross and Blue Shield of North Carolina. If you have an HMO or POS plan, there are some additional services you'll need approval for. Preventive care includes routine well exams, screenings and immunization intended to prevent or avoid illness or other health problems. This new site may be offered by a vendor or an independent third party. Screening for high cholesterol is also covered at 100% every 5 years or annually for those with increased risk for CVD. http://www.breastcancer.org/symptoms/understand_bc/statistics
Fortunately, only about 1 in 400 people have a BRCA gene. Routine mammograms are covered by the state health plan at no cost to you. Mammograms are the best way to screen for breast cancer and can detect cancer up to three years before other signs and symptoms appear. This new site may be offered by a vendor or an independent third party. Why did Blue Cross NC implement a diagnostic imaging management program? Salpingectomy for sterilization purposes will be covered as preventive effective 7.1.22, Trans-dermal contraceptives (i.e., contraceptive patches), Diaphragms are available only through the pharmacy and IUDs are available only through a professional provider, If there is a medical reason you cannot take a generic contraceptive, your doctor should review this, Diaphragms, vaginal rings, contraceptive patches, female condoms, sponges, spermicides, and emergency contraception are available only with a prescription. "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 . Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. This document provides you with information about how your claim was paid, including your payment responsibility or reimbursement, if any. The issue of return on investment and appropriateness of guidelines will be continually addressed as part of the evaluation of the program. 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 statin, your doctor should review this. As a result, 3D mammograms lower the number of false alarms. 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. Olvido su contrasea? Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. 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. Forgot User ID? If something is found in a preventive screening mammogram, the screening is still at no cost to the member. Blue Cross and Blue Plus health plans cover both 2D and 3D preventive screening mammograms at no cost to members when you use an in-network provider. Most breast cancers are found in women 50 years old and older. You can also visit our Mental Health Resource . Blue Shield of California 1999 . Screening for depression in postpartum women. 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. %%EOF
Cat-scan technology exposes patients to more radiation than an X-rays. Enroll Now. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Mammograms are a key component of a womens preventative care. During this visit, your doctor examines your overall health. BSC6.07 Digital Breast Tomosynthesis. If there is a medical reason you cannot use a generic bowel preparation medication, your doctor should review this. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. For more information, view our privacy policy. Understand the difference between preventive and diagnostic. Approve annually starting at age 30; Individuals not yet tested for BRCA gene, but with known BRCA mutation in first degree relative. (MAMMOGRAPHY) (Coverage Policy 2011018) USPSTF Recommendation. The program is expected to assist Blue Cross NC in improving affordability for our members. NRT through the pharmacy benefit is available only with a prescription. By continuing to use this website, you consent to these cookies. By continuing to use this website, you consent to these cookies. 140 0 obj
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Preventive Care Plans & Guidelines. Limited to a 90 day supply each for two cessation efforts. "To put it in perspective, the dose of radiation is lower than that of a chest x-ray," Mehta said. . , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. How do 3D Mammograms Differ From Standard Ones? Mammograms are one of the best ways to find it early. However, if her doctor schedules a follow up mammogram six months later to re-examine that change, it would be used to diagnose a symptom, so it . Breast cancer is the most common type of cancer in women. Register Now, Ancillary and Specialty Benefits for Employees. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Servicing providers (hospitals, freestanding imaging centers, etc.) When it's diagnostic: If your doctor . 1 If you have gotten one dose of Zostavax vaccine for shingles, you should also get the two doses of Shingrix vaccine. There are also additional guidelines if you're pregnant. Standard 2D mammograms take two pictures of the breast. Fargo, N.D., 58121. External link You are leaving this website/app (site). However, your group may decide to delay the effective date for coverage until your group's plan . All rights reserved. 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. hrHPV test only every 5 years. For more information, view our privacy policy. We have an obligation to our members to provide quality care at an affordable price. Psychotherapy. 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. 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). Another Reason to Get Moving: Exercise Can Help Lower Cancer Risk. Mammograms arent as painful as you think you may feel a little pressure but it only lasts a few seconds. No lump, no cancer. Routine physical exams where your doctor reviews the following: This exam is prevention focused, not problem focused. 30 and above: obese. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics. You will be required to pay the plan's physician office copayment or coinsurance. What information is required to request prior approval? 122 0 obj
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Obesity screenings. To capture them, the breast is pulled away from the body, compressed and held between two glass plates. 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. The diagnostic imaging management program guidelines are based on the most up-to-date recommendations of physician organizations such as the American College of Radiology and the American College of Cardiology. Breast cancer mammography screenings for women over age 40; Colorectal cancer screening for adults over age 45; . If physicians have questions about the Blue Cross NC diagnostic imaging management program, they should contact their local Network Management representatives. "To put it in perspective, the dose of radiation is lower than that of a chest x . 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. Breast cancer is the second leading cause of cancer deaths among women in the U.S. Health coverage is offered by Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. For this reason, 2D mammograms can sometimes produce inaccurate findings. *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 . A normally functioning BRCA gene helps prevent cancer by suppressing tumor growth. The goal of the diagnostic imaging program is to improve affordability of health care to Blue Cross NC members. It may also be used to depict residual disease after neoadjuvant chemotherapy. Here's how to interpret your BMI: Below 18.5: underweight. The goal of the Blue Cross NC Diagnostic Imaging Program is to improve affordability for Blue Cross NC members. . When were Blue Cross NC's diagnostic imaging prior approval policies effective? About 10% of patients who receive routine mammograms get called back for another look. Annual physical exams and other preventive services are free when you use a Preferred provider. Copyright 2023 Health Care Service Corporation. Privacy Policy Additionally, we cover computer-assisted detection for those women who seek an extra level of screening for breast cancer. January 25, 2016. Learn more aboutmammogram screeningsin this video. Genetic counseling and evaluation can help determine if youve inherited a BRCA mutation. 2 The HPV vaccine (Gardasil) is covered to age 45 per the Food and Drug Administration (FDA) guidelines. 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. Register Now, Ancillary and Specialty Benefits for Employees. Tests that do not meet national clinical guidelines will not be approved. to expand insurance coverage for diagnostic mammograms. Talking with your healthcare provider about the . When it's preventive: You get a mammogram to check for breast cancer. Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross Blue Shield Association, serving residents and business in North Dakota. BATON ROUGE - October is Breast Cancer Awareness Month. MRI of the breast is a useful tool for the detection and characterization of breast disease, assessment of local extent of disease, evaluation of treatment response, and guidance for biopsy and localization. Has Blue Cross NC considered disallowing self-referrals? What imaging procedures require prior plan approval? We use cookies on this website to give you the best experience and measure website usage. Heres everything you need to know about it. This is especially important for women who have dense breast tissue. 2023 Blue Cross and Blue Shield of North Carolina. Description: clinicians offer pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess gestational weight gain in pregnancy. Talk to your doctor to find out which of these you should have based on your health. Annual physical exams and other preventive services are free when you use a Preferred . Which health plans does the program apply to? Still, over the past decade, there have been advances in mammogram technology. No lump, no cancer. Assessing Your Risk 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. Scenario 1: Brand Truvada, Viread, or Descovy may be made available if you are clinically unable to use generic Truvada. 0
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