How The Program Works

This Program ONLY pays for medical services related to breast and cervical cancer.

 

WHO IS ELIGIBLE?

You must:

• Be a Maryland resident (if you move out of State, you are no longer eligible) and proof of residency is required, and

• Meet the income requirements for the Program, and

• Meet the medical requirements.

  Note:  Those covered by Medical Assistance are not eligible for this Program

   

  WHAT ARE YOUR RESPONSIBILITIES?

  You must:

• Complete and sign the application for the Program, provide proof of Maryland residence, and provide proof of income.  (If you have no income, you must provide a notarized letter stating that fact.)

• Show the Program "ID" letter each time you visit a Program provider.  PLEASE KEEP THE ORIGINAL LETTER.

• Visit only Program Providers. You can determine which providers participate by calling your local contact or the central office in Baltimore. You will be responsible for bills from non-Program providers if they do not choose to participate in the Program.

• Let the Program know when:

• your income changes, or

• your health insurance changes, or

• your in-state address or phone number changes, or

• you move out of the State, or

• you have questions about the Program

• Renew your application to the Program each year if you are found to have breast or cervical cancer or you continue to have a breast or cervical abnormality needing further treatment.

• You may also be asked to complete an application for Maryland Medical Assistance if the program deems you to be potentially eligible.

   

 

 

WHAT MEDICAL SERVICES ARE COVERED?

Only services directly related to the diagnosis and treatment of breast and/or cervical cancer will be paid by the Program.  These include:

• Tests to check for breast cancer (diagnostic procedures) (e.g.  ultrasound, breast biopsy, etc.)

• Breast cancer treatment procedures (e.g. lumpectomy, mastectomy, radiation therapy, or being part of a research study)

• Tests to check for cervical cancer (diagnostic procedures) (e.g. colposcopy, cervical biopsy)

• Cervical cancer treatment procedures (e.g. cryotherapy, laser, hysterectomy, etc.)

• Medications related to the treatment of breast or cervical cancer

• Occupational Therapy and Physical Therapy for breast or cervical cancer

• Wigs

• Medical Equipment (one external prosthesis every 3 years, two mastectomy bras each year, hospital beds, etc.)

• Breast reconstruction (nipple reconstruction or tattooing are NOT covered)

• Other costs related to diagnosis and treatment (lab tests, x-rays, or hospital care)

   

  WHAT SERVICES ARE NOT COVERED BY THE PROGRAM?

• Pap tests

• Head coverings other than wigs

• Experimental procedures

• Home health aides (Home health nurses, occupational and physical therapists are covered)

• Transportation including ambulance services.

• Medications for conditions other than the treatment of breast and/or cervical cancer (e.g. insulin, heart medications, etc.). If the treatment for breast or cervical cancer causes the need for treatment of other conditions, the Program may pay for those medications.

• Nipple reconstruction/tattooing

• Genetic testing

• Prophylactic mastectomy (removal of a breast with no cancer)

   

 

 

HOW DOES PAYMENT UNDER THIS PROGRAM WORK?

• The Program can only pay providers who have signed a written agreement to participate in this Program.  Providers may be doctors, hospitals, pharmacies, home health agencies, laboratories, free standing ambulatory surgical centers, medical supply companies, physical therapists and occupational therapists.

• The Program pays providers directly.  (No payment is made to a patient.)

• If you are uninsured, the Program pays the provider for the breast and/or cervical cancer diagnostic or treatment procedures you received

• If you have Medicare or commercial insurance your provider will bill your insurance first

• If you are covered by Medicare or commercial insurance, the Program will pay for:

• Your patient co-insurance amount and any co-pay

• Your annual deductible if it has not already been met

• Services related to breast and cervical cancer that are not covered by Medicare or commercial insurance

   

  REMEMBER:

• If you have any questions or get a bill, call your local contact.  If you have no local contact, call the central office and ask for a diagnosis and treatment nurse.

• The Program ONLY covers services related to breast or cervical cancer.

• You must use Program providers.

• You MUST show your gold seal “ID” letter each time you use a Program provider.  Be sure the provider notices the “Send Billing to:” section of the ID letter.

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