Maine CDC Breast and Cervical Health Program (MBCHP)


Free Pap Tests & Mammograms


In order for MBCHP to provide the best service possible to our members and to make sure your breast and cervical cancer screening services are paid for by MBCHP, please keep in mind the following:


Office Visits


 

  • MBCHP contracts for breast and cervical cancer screening services with service locations; these locations make up  the MBCHP provider network. MBCHP does NOT contract with individual health care providers, i.e., individual doctors or nurses.
  •  MBCHP network service locations contract with MBCHP and agree to accept members for breast and cervical cancer screening office visits only and agree to accept the MBCHP rate paid for these cancer screening services as payment in full.
  • MBCHP will reimburse MBCHP network service locations for a breast and/or cervical cancer screening office visit only if it includes one or more of the following breast or cervical cancer screening services:
    • A Clinical Breast Exam
    • A Pelvic Exam
    • A Pap test
      • Every 3 years if a Pap test, or
      • Every 5 years if Pap test with HPV test (HPV co-testing)
    • *Note: If you've had a hysterectomy, a Pap test will be paid for only if the hysterectomy was related to cervical cancer or if part of your cervix remains.
  • MBCHP will NOT reimburse for an office visit if NO breast or cervical cancer screening service is performed at the time of the visit. (NOTE: scheduling a mammogram during the office visit is NOT considered a breast or cervical cancer screening service and MBCHP will not reimburse for an office visit where the only service listed on the visit form is “mammogram scheduled”.)
  • You must select a MBCHP network service location at initial enrollment and at annual re-enrollment.
  • If you receive your breast and cervical cancer screening office visit from a provider location other than the network service location you selected at enrollment (listed below your name on the front of your MBCHP member card), your office visit claim may be denied and you may receive a bill from that provider.
  • If you refuse to have breast or cervical cancer screening services that are offered during your breast and cervical cancer screening office visit, your office visit claim may be denied by MBCHP and you will be responsible to pay for the office visit as no breast or cervical screening service was performed.
  • If during your office visit, the health care provider at the network service location refers you to another provider for diagnostic services, you must contact MBCHP at (800) 350-5180 and ask to speak with the Case Manager to find out whether or not MBCHP will cover the services you are being referred for. If you have services that MBCHP does not cover, MBCHP will deny the claims from the provider and you will receive a bill from the provider for those services that MBCHP does not cover.
  • After being seen at a diagnostic network service location for diagnostic services, you must return to your network service location for routine breast and cervical cancer screening services. You can not continue to visit the diagnostic network service location for your routine screenings; doing so may result in your office visit claims being denied by MBCHP and your receiving a bill from the provider.

Mammograms


A mammogram (at a mammography site that participates in MBCHP) (NOTE: MBCHP does not cover computer aided detection (CAD)).


Diagnostic Testing


Further diagnostic tests for breast or cervical cancer, if needed (you must be referred to a diagnostic provider site that participates in MBCHP by your MBCHP network service location) :

  • Diagnostic mammograms
  • Fine needle aspiration of a breast cyst
  • Breast ultrasound after a mammogram
  • Breast biopsy (hospital charges are not covered)**
  • Colposcopy (magnified view of the cervix) with or without biopsy
  • Human Papilloma Virus (HPV) testing, after abnormal Pap test result
  • Pathology charges for breast and cervical biopsies
  • Anesthesia for breast biopsies
  • Surgical consults for possible breast or cervical cancer
  • **Note: if your doctor wants other tests or if you go to the hospital, you should talk with their staff about how you will pay the medical bills. MBCHP does not cover all health care services; physician charges are covered by MBCHP but hospital charges are not covered.

MBCHP only pays for covered breast and cervical cancer screening services performed during your office visit at the contracted MBCHP network service location you selected at initial enrollment or re-enrollment (listed on the front of your MBCHP member ID card below your name) or the MBCHP approved participating diagnostic network service location you were referred to by your MBCHP network service location. Your MBCHP network service location provider must order all tests.

MBCHP does not pay for urine tests, blood tests, stool tests, bone density test, transvaginal ultrasounds, pelvic ultrasounds, chest x-rays, MRI's, colonoscopies (exam of the bowel) or any prescriptions, including birth control.

If you need financial assistance for tests not paid for by the MBCHP, or have more questions about a breast or cervical cancer issue, you can call our Case Manager at 1-800-350-5180 and press 1, or 207-287-8068, for help.

Updated June 10, 2014