Mammograms are a vital tool in the early detection of breast cancer. Understanding your insurance can help you plan for this test and could make a life-saving difference.
A mammogram is a specialized X-ray that examines breast tissue to check for signs of breast cancer, often before showing any symptoms. The results of your mammogram can help doctors decide if more testing is needed, such as a breast tissue biopsy.
Research suggests that regular mammograms boost early breast cancer detection rates. Since the 1980s, breast cancer screening programs have helped drop breast cancer mortality rates by as much as 40-50%.1 Now, the five-year survival rate for early-detected breast cancer is almost 99%.1
Under the Affordable Care Act (ACA), most insurance plans cover screening mammograms for women 40 and older. But diagnostic mammograms may not be fully covered. Check your explanation of benefits for coverage details.2
This is usually for people with no cancer symptoms. They help detect early changes in breast tissue. The widely used screening is 2D digital imaging, but 3D digital breast imaging techniques provide greater detail and are becoming more common in routine screenings.
Doctors use this more detailed imaging exam when a patient is experiencing breast cancer symptoms or if a screening mammogram shows unexpected findings. It captures more details for a closer evaluation.
Before going to get a mammogram, you can get a better understanding of your insurance coverage and potential costs by:
- Clarifying whether the exam will be billed as a screening or diagnostic mammogram. Talk with your doctor to determine what type of mammogram you need.
- Reviewing your insurance coverage to understand any potential out-of-pocket costs. Remember that diagnostic mammograms often have deductibles or copayments.
- Checking your plan's annual limits and confirm the facility is in-network.
Get reliable answers to your insurance questions, such as how to get prior authorization and submitting a claim.
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. Learn more about our non-discrimination policy and no-cost services available to you.
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