We cover mammograms, subject to the terms of your specific plan, based on what you and your healthcare provider decide is best for you, your risks and preferences. Mammograms, an x-ray of the breast, can detect tumors that can't be felt, but can also lead to false positives, particularly in younger women with dense breasts. Mammograms also require small doses of radiation. While risk of harm is low, repeated x-rays can be harmful.
If you decide a mammogram is right for you, one mammogram per year is considered preventive care under most health plans. We also offer coverage for computer-aided diagnostic and 3-D mammography.
If you're having a mammogram as a result of an abnormality, your mammogram will be billed as a diagnostic test and is subject to co-insurance or deductible.
Sometimes a doctor will recommend an ultrasound or magnetic resonance imaging (MRI) in addition to a mammogram. That is typically billed as a diagnostic test and is subject to coinsurance or deductible. It's not covered as preventive.
If you’re referred for additional breast or cervical cancer screening, a Premera nurse might call to offer support and answer any questions you might have.
Breast cancer due to a genetic disorder is not common, only 5-10 percent of all breast cancers are inherited. If you are concerned about a family history of breast and other cancers, including ovarian, tubal and peritoneal, talk to your doctor about your risk and the possibility of being tested for BRCA1 and BRCA2, genes that increase risk of breast and ovarian cancers.
We require preapproval for genetic testing to protect customers from unexpected bills. Your in-network healthcare provider can request authorization for you. When done without a cancer diagnosis, the test is considered preventive and covered at 100 percent under most health plans. Breast cancer preventive medications, such as Raloxifene, Soltamox, and Tamoxifen are covered for women who have had breast cancer or whose BRCA test revealed higher risk.
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Benefits under your health plan may differ, so refer to your benefit booklet for information on what your specific health plan covers.
Your health plan covers preventive care services as required by state and federal law. For more information, please review the "A" and "B" rated services on the United States Preventive Task Force, immunizations recommended by the Centers for Disease Control and Prevention and preventive care and screening recommended by the Health Resources and Services Administration. See the list on healthcare.gov.
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