MBCHP Covered Services - Frequently Asked Questions.

*About breast biopsies:
If your MBCHP provider recommends a breast biopsy, talk to the MBCHP Patient Navigator regarding coverage of hospital charges not covered by MBCHP.

Covered Services - Frequently Asked Questions.

1. Does MBCHP cover breast Magnetic Resonance Imaging (MRI)?

• Starting January 1, 2019, MBCHP may be able to cover a breast MRI under certain conditions and only after it has been pre-approved by the MBCHP Patient Navigator. MBCHP providers were sent a letter on this new change.

2. Does MBCHP cover an endometrial biopsy?

• MBCHP can only cover an endometrial biopsy (EMB) if the client's screening Pap test reported:
  • Abnormal Glandular Cells (AGC), or;
  • Adenocarcinoma In-Situ (AIS), or;
  • Negative Pap result, with endometrial cells present AND the client is post-menopausal.

  3. Does MBCHP pay for the MBCHP provider to remove a cervical polyp?

  • If a MBCHP provider determines the need and provides documentation of the polyp type, the Program will cover:
    • Removal of an endocervical polyp and pathology, and/or;
    • Biopsy of an endocervical polyp and pathology.

    4. After I had an abnormal screening result, I was referred to a MBCHP diagnostic service location. Can I continue going to the MBCHP diagnostic provider to have my Pap tests?

    • No, you must see the MBCHP network service location listed on your MBCHP member ID card for Pap tests.

    5. If I am diagnosed with breast or cervical cancer, does MBCHP pay for my cancer treatment services?

    • No, but if you are diagnosed with breast or cervical cancer, MBCHP will determine if you qualify for the MaineCare Treatment Act or other resources for treatment support services. If you have been diagnosed with breast or cervical cancer, call our Patient Navigator at 1-800-350-5180 to see if you might be eligible.
    • MaineCare Treatment Act informational brochure

    6. Will the MBCHP pay for a human papillomavirus (HPV) test?

    • The high risk human papillomavirus (hrHPV) test is covered as part of a regular cervical cancer screening exam if done alone as a primary screening test (as of January 1, 2019), or in conjunction with your Pap test (called co-testing). Make sure you talk to your health care provider about which test works is best for you. Whether you have a Pap test, a Pap test with a high risk HPV (hrHPV) test (co-testing), or a high risk HPV (hrHPV) test will determine how long you should go between visits and when your next cervical cancer screening is recommended.

    7. Does the MBCHP cover a pelvic or a transvaginal ultrasound?

    • MBCHP can only cover an endometrial biopsy (pelvic/transvaginal ultrasound) if the client's screening Pap test reported:
      • Abnormal Glandular Cells (AGC), or;
      • Adenocarcinoma In-Situ (AIS), or;
      • Negative Pap result, with endometrial cells present AND the client is post-menopausal.

      8. I will need to have a LEEP. Will MBCHP cover this procedure?

      • If you should need this procedure, please contact the MBCHP Patient Navigator BEFORE your provider schedules this procedure. Any cervical diagnostic excisional procedure requires MBCHP Patient Navigator authorization.

      9. Does MBCHP cover a hysterectomy?

      10. Does MBCHP pay for a urine test?

      11. My MBCHP network service location is recommending that I have a colposcopy (magnified view of the cervix). Will MBCHP cover this procedure?

      • Yes, the MBCHP covers a colposcopy with or without a biopsy. If you should need to have this procedure, please contact the MBCHP Patient Navigator.

      12. I received a bill for something that I think should be covered by MBCHP. Who should I contact?

      • If you received a bill for a service that you thought should have been covered by MBCHP, please contact the MBCHP Medical Care Coordinator at 207-287-6285 to have the bill reviewed.

      Updated January 15, 2019

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