Maine CDC Breast and Cervical Health Program (MBCHP)


Enrollment - Frequently Asked Questions...


 

1. How do I know if I qualify for MBCHP?

2. I have health insurance, i.e., Anthem, Aetna, or other Health Insurance Exchange plan; can I still qualify for the MBCHP?

  • You may still be eligible for MBCHP services even if you currently have health insurance. Your health insurance covers the office visit for preventive breast and cervical cancer screenings, mammograms and Pap tests, (under the Affordable Care Act, all health insurance plans are required to cover these preventive services at no charge to you) but your insurance may apply any recommended breast or cervical cancer screening follow-up test charges towards your unmet deductible. Your provider will then bill you for the balance the insurance company does not pay.
  • For example, if you have an "inconclusive" mammogram and your doctor refers you for a follow-up mammogram, the follow-up mammogram may be coded as "diagnostic" (it is still a "covered" service under your insurance plan, but if you have not met your deductible for the year, you may be responsible for paying for these follow-up tests. Check with your health insurance plan administrator to find out if your follow-up tests will be paid for by them or not.)
  • Call the MBCHP to see if you qualify for MBCHP coverage of breast and cervical cancer screening follow-up testing that may not be paid for by your health insurance:
    • 1-800-350-5180...or;
    • 207-287-8068...or;
    • TTY Users dial 711 (Maine Relay)

3. Can I still go to my regular doctor to get my MBCHP screenings services?

  • Maybe. The MBCHP works with a network of health care provider service locations all over the state. In order to have the MBCHP pay for covered services you must be seen at a contracted MBCHP network service location. If your regular doctor practices at the MBCHP network service location you chose when you enrolled (listed on the front of your MBCHP member ID card) then the MBCHP would pay for your screenings. However, if your regular doctor participates in the MBCHP at one of our network service locations but provides your service at a different location (not the network service location listed on your membership ID), your service may not be paid for by MBCHP.
    • 1-800-350-5180...or;
    • 207-287-8068...or;
    • TTY Users dial 711 (Maine Relay)

4. My regular doctor (not the MBCHP network service location I enrolled at) usually does my referral for my mammogram. Will MBCHP still pay for my mammogram.

  • If you get a referral from your "usual" doctor (not a health care provider at the MBCHP network service location you signed up for when you enrolled with the MBCHP) for your mammogram, the results of your mammogram will be sent to your doctor. Unless you have specifically asked for results to be sent to your MBCHP network service location and/or MBCHP, we will not receive your results. If the MBCHP does not receive results of your mammogram, the MBCHP may not pay for your mammogram. If the MBCHP paid for your mammogram and cannot get a copy of the results, the amount paid for the claim may be recouped by the MBCHP. If this happens, you will receive a bill for your mammogram. If you have questions, please contact us.

5. Can I "self-refer" to my mammography site and avoid having to have an office visit at my MBCHP PCP network service location?

  • Yes, if you do not need to see your MBCHP network service location for an office visit, i.e., you are not due for a Pap test, and just want to have your mammogram done, you can self-refer at many MBCHP mammography sites in Maine. If you self-refer for your mammogram, please:
    1. Make sure you tell them you are enrolled in the MBCHP (so they will bill us),
    2. Provide the mammography site with your MBCHP member number (the 9 digit number followed by an "A" on your MBCHP member card),
    3. Ask the mammography site to send the MBCHP (and your MBCHP network service location) a copy of the results of your mammogram. This is very important in case your mammogram is not normal. If you do not have a normal result from your mammogram, your MBCHP network service location may need to schedule an additional view or make referrals for any diagnostic testing that may be required.

6. I just had a mammogram or Pap test: if I join, will MBCHP pay for those tests?

  • If you qualify and join the program, the MBCHP can backdate your enrollment start date up to 90 days to pay for covered services performed at a MBCHP network service location service location or participating mammography site.

7. After joining the Program, I received a bill: what should I do with it?

  • You should not receive a bill for any MBCHP covered service if the service was performed at the MBCHP network service location listed on the front of your MBCHP member ID.
  • If you do receive a bill, please call the provider and give them the ID # on your MBCHP enrollment card.
  • If you receive a second bill, please call the MBCHP immediately and we will try to help straighten it out.

8. Do I have to reapply every year to be a part of MBCHP?

  • Yes, the MBCHP offer services to you every year as long as you are still eligible and you re-enroll.
  • Once a year, the MBCHP will send a form for you to update your enrollment information.
  • The re-enrollment form must be completed, signed on both pages, and returned to the MBCHP to stay on the program.
  • If you do not return the re-enrollment forms to the MBCHP, your coverage will automatically end and any services you have after your enrollment ends, may not be paid for by the MBCHP.
Updated April 22, 2016