Prostate Cancer Screening Benefit Level Change

September 13, 2018

Currently, Blue Cross and Blue Shield of TX (BCBSTX) covers prostate cancer screening at no member cost share when billed with a preventive diagnosis.

Beginning Jan. 1, 2019, this screening will no longer be covered at the no member cost share level, but will instead be treated as a standard medical benefit, and any applicable cost sharing (copay, coinsurance and deductible) may apply, based on the member’s health plan.

This initiative applies to all non-grandfathered retail and group members. It does not apply to members who have Medicaid or Medicare plans.

What does this mean for you?

  • You may now need to seek payment from both BCBSTX and the member.

Note: Some groups may elect to continue coverage at the no member cost share level. Members may confirm their coverage by calling the number on the back of their customer ID card.

You should check eligibility and benefits electronically through Availity®, or your preferred Web vendor. Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized 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 back of 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 BCBSTX. BCBSTX 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.