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PDF Understanding Cost & Coverage Issues - Komen.org A high BMI can be a warning sign for potential health problems. 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. Summary of Preventive and Contraceptive Services - CareFirst You should get screenings every one or two years, depending on your doctor's advice. Copyright 2023 Health Care Service Corporation. As a result, 3D mammograms lower the number of false alarms. They'll also look for early signs of breast and cervical cancer. Wellness service benefits pay you money*. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. If you have an HMO or POS plan, there are some additional services you'll need approval for. Texas insurers to cover advanced breast cancer screenings Breast health screenings | BCBSND We use cookies on this website to give you the best experience and measure website usage. Copy. Preventive care includes routine well exams, screenings and immunization intended to prevent or avoid illness or other health problems. Issuance of a prior approval number is not a guarantee of payment. 0 Who can physicians call if they have questions? We believe that it is critical to carefully examine the appropriate use of outpatient, nonemergency diagnostic imaging procedures to make sure that the benefit of the procedure outweighs the risk. Register Now, Ancillary and Specialty Benefits for Employees. 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. This new site may be offered by a vendor or an independent third party. Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. In fact, we rank 32nd out of 50 states. Of the 4 million women age 40 to 65 in Texas, 2.6 million . Scenario 2: Your claim for emtricitabine/tenofovir (generic Truvada) or Apretude is not paying at 100% and you are using it for PrEP.