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Prostate Cancer Screening Benefit Change

Posted September 24, 2018

Currently, Blue Cross and Blue Shield of Illinois (BCBSIL) covers prostate cancer screening at no cost to the member when it is billed with a preventive diagnosis. Beginning Jan. 1, 2019, this screening will be treated as a standard medical benefit and may be subject to a copay, coinsurance and deductible, based on the member’s health plan. This means you may now need to seek payment from both BCBSIL and the member.

BCBSIL preventive services coverage aligns with the grade A and grade B recommendations of the United States Preventive Services Task Force (USPSTF), Health Resources & Services Administration, Advisory Committee on Immunization Practices, and the Centers for Disease Control and Prevention (CDC). Prostate cancer screening is not an A or B recommendation of the USPSTF, so this change is being made to align prostate cancer screening with the coverage offered for other similar C grade recommendations.1

This change applies to all non-grandfathered commercial PPO and HMO members but some employers may have chosen to continue allowing this service at no cost for their employees. Checking eligibility and benefits electronically through Availity®, or your preferred vendor portal, is strongly encouraged. Members may also confirm their coverage by calling the number on their BCBSIL ID card.

This change does not apply to members who have Medicaid or Medicare plans.

1U.S. Preventive Services, Final Recommendation Statement, Prostate Cancer: Screening, May 2018, https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prostate-cancer-screening1

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment.

Checking eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s ID card.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.