Ladies First Services

Ladies First pays for the following services

Breast Screening

(21+)

  • Clinical breast exam
  • Breast self-exam instruction
  • Screening Mammogram
  • Diagnostic Mammogram
  • Ultrasound
  • Consultation
  • Second opinion
  • Breast biopsy

Ladies First members can be referred for full health coverage during treatment. Contact the Clinical Navigator at 802-863-7332.

Cervical Screening

(21+)

  • Pelvic exam
  • Pap smear every 3 years
  • Pap smear & HPV every 5 years
  • Colposcopy
  • Diagnostic tests

Ladies First members can be referred for full health coverage during treatment. Contact the Clinical Navigator at 802-863-7332.

Cardiovascular Disease Screening

(30+)

  • Annual office visit
  • Blood pressure
  • Total cholesterol
  • Lipid profile
  • Blood glucose
  • HgA1c

CVD treatment services are not covered

Lifestyle Programs

(30+)

  • Weight Watchers
  • Curves Complete
  • TOPS (Taking Off Pounds Sensibly) 
  • YMCA Diabetes Prevention Program
  • FitLogix
  • Blood Pressure Self Management 
  • Health Coaching
  • Local Fitness Centers

Breast and Cervical Cancer Treatment Program

Treatment eligibility criteria:
  1. Be enrolled in Ladies First.
  2. Be screened for breast or cervical cancer by Ladies First.
  3. Be diagnosed with breast cancer, cervical cancer or a pre-malignant condition (cervical dysplasia).
  4. Require treatment services.
  5. Have no other health insurance.
  6. Be a U.S. citizen or a qualified alien.
  7. Be under age 65.

Send all abnormal breast and cervical cancer screening results to Ladies First. The Clinical Navigator will guide Ladies First members who have been diagnosed with cancer through the process of applying for the BCCT Program. This program provides full Medicaid benefits for up to 5 years during treatment.

More on Ladies First Clinical Navigation

BCCTP Application

Effective January 2017:

The mission of Ladies First is to remove barriers to breast cancer, cervical cancer, and cardiovascular disease risk factor screening for low income women.  To do this, Ladies First pays for breast and cervical cancer screening and diagnostics. Ladies First can also pay for an annual appointment for members to receive their clinical breast exam, Pap test, and heart health screening. As determined by the grant from the CDC, Ladies First covers screening appointments which can be best represented by E/M codes 99201-99205 and 99211-99215.

In January of 2017, codes 99385, 99386, 99395, and 99396 (Preventive Visits) were added. It is important to keep in mind that Ladies First can only pay for the services and blood testing that is outlined in the fee schedule. Ladies First cannot pay for TSH testing, STD testing, Colonoscopies, or Bone Density Scanning. Ladies First urges providers to discuss with Ladies First members the potential charges that come with testing and procedures that are not covered by Ladies First. 

Non-covered Services

  • Pelvic and trans-vaginal ultrasound
  • Endometrial biopsy (unless patient has Atypical Glandular cells of Undetermined Significance (AGUS) Pap test results).
  • Cervical conization (can be covered by the Vermont Breast and Cervical Medicaid Treatment Program if eligible)
  • Computer-aided diagnostic test (CAD)
  • Gonorrhea, chlamydia STD tests
  • Electrocardiogram
  • Thyroid stimulating hormones test (TSH)
  • Bone density test
  • Screening MRIs (only high-risk MRIs are allowed)

Click here to view Ladies First member eligibility. 

 

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Contact Ladies First

Vermont Department of Health
108 Cherry Street
P.O. Box 70, Drawer 38
Burlington, VT 05402
Phone: 800-508-2222
Fax: 802-657-4208

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