Every Woman Matters Program
Helping Women Live Healthier Lives

Answers to Questions About Common Procedures

         Q. What Services are Covered under the Every Woman Matters Program?

A. For services covered by Every Woman Matters, you must make your appointments with a contracted provider listed in the Doctor/Clinic list. When you make your appointments, ask if the doctor/clinic is contracted with Every Woman Matters. If you are still unsure or have questions concerning the doctor/clinic, please call 1-800-532-2227.

Screening Services Available:

Screening Services are performed on a regular basis to maintain your health.

Women Under 40 years of age: No Services Available*

*If you are under 40 and were enrolled in Every Woman Matters prior to July 1, 1997, you were “grandmothered” into the program, therefore you can have the following services: Pap Smear ** with a Pelvic Exam; Clinical Breast Exam; Teaching of Breast Self-Exam

screening services for: Women 40 through 64 years of age: Pap Smear ** with a Pelvic Exam; Clinical Breast Exam; Teaching of Breast Self-Exam; Screening Mammogram; Blood Pressure Check; Height and Weight Check; Lipids/Triglycerides Check; Glucose or A1c if previously diagnosed with diabetes

Women 65 years of age and above: No Services Available

Diagnostic Services Available:

Diagnostic Services are performed when a health problem is suspected.  If you need diagnostic services, your doctor will notify you.

Women under 30 years of age: Colposcopy-directed biopsy; Repeat Clinical Breast Exam; Referral for breast lump evaluation; Fine Needle/Cyst Aspiration of the Breast; Ultrasound Guided Cyst Aspiration/Fine Needle Aspiration; Breast Biopsy of any kind

Women 30-39 years of age: All diagnostic services listed for women under 30 years of age; Diagnostic Mammogram 

Women 40 through 64 years of age: All diagnostic services listed for women 30-39 years of age; Breast Ultrasound

Women 65 years of age and above: No Services Available

** If you have had three (3) normal Pap tests within three (3) years, you may not be eligible for a Pap test or you may not need a Pap test. Your provider will discuss this with you.  You will have a salmon colored Screening Visit Card in the Screening Packet you receive from Every Woman Matters only if you have had three (3) normal Pap tests three (3) years in a row while on the Every Woman Matters Program.  On the card is a list of reasons that your provider could order a Pap test more often then every three years.  The reasons are items that can increase a woman’s risk for cervical cancer.   NOTE:  If you have a Pap test for a reason not on the list on your Screening Visit Card, payment for the Pap test will be your responsibility.  Discuss with your provider how to pay for this.

Additional Services:

Women under 40 years of age: No Services Available

Women 40-64 years of age: Follow up Pap smears after abnormal Pap smear/Colposcopy with Biopsy; Follow up Clinical Breast Exam; Follow up Mammogram; One repeat blood draw for elevated lipids, triglycerides, glucose; One repeat blood pressure check; One counseling visit with a contracted provider for lifestyle intervention; Every Woman Matters lifestyle interventions for healthy living

Women 65 years of age and above: No Services Available

Every Woman Matters does NOT pay for:

Women under 40 years of age and women 65 years of age and above: Screening Visit Services; Any screening mammograms or ultrasounds; Screening for heart disease and diabetes; Programs to learn about how to change your diet, exercise, and/or stop smoking

All clients: Exams done before you enrolled in Every Woman Matters; Other tests the doctor may order at the visit such as a urine test, pelvic ultrasound, endometrial biopsy, or blood tests (other than to test for glucose or cholesterol); Diagnostic exams not listed above; A pelvic exam done alone without a Pap test or other covered services; Treatment-If diagnosed with breast or cervical pre-cancer or cancer, program staff or Medicaid staff will check client income and help you find the most appropriate treatment resources; Inpatient hospital or treatment services- treatment services include any medical or surgical services or medicine prescribed by a doctor (i.e., cancer medication, radiation, etc.)

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What is a Breast Biopsy?

The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.  If a lump in the breast tissue is found, the doctor may need to remove a small piece of the lump.  A pathologist views the tissue under a microscope to look for cancer cells.

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What is a Pap Test and Pelvic Exam?

A Pap test is a way to look at a sample of cells taken from a woman's cervix (the opening to the womb).  The test is used to look for changes in the cells of the cervix that show cervical cancer or conditions that may devlop into cancer. If detected early, cervical cancer can be cured.

The Pap test is done during a pelvic exam.  A doctor uses a device called a speculum to widen the opening of the vagina so that the cervix can be examined.  A plastic spatula or small brush are used to collect cells from the cervix.  The sample is then spread on a slide (Pap smear) or mixed in a liquid solution (liquid-based Pap test) and sent to a lab for examination under a microscope.

Every Woman Matters recommends and can pay for a Pap test according to the following rules:

-Pap Test (conventional Pap smear)                                    -Yearly until you have three normal Pap smears
-Liquid-based cytology or liquid-based Pap test                 -Every other year as long as your Pap test is normal

After the Pap test, the nurse or doctor will do a pelvic exam to check your fallopian tubes, ovaries, and uterus (womb) by putting two gloved fingers inside your vagina.   With the other hand, he/she will feel from the outside for any lumps or tenderness.  This takes only a few minutes.   

Remember, EWM can only pay for this important test if you also have a Clinical Breast Exam or other services performed at the same appointment.

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What is a Clinical Breast Exam(CBE)?

A clinical breast exam is when a trained healthcare provider checks your breasts for lumps.  The provider will look at and feel your breasts for any changes.  The Every Woman Matters program (EWM) and the Centers for Disease Control and Prevention (CDC) recommends that you have a clinical breast exam every year.

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What is a Mammogram?

A mammogram is an x-ray picture of the breast.  You will have x-rays taken of one breast at a time. A mammogram can find breast cancer that is too small for you or your health care provider to feel. When you get your mammogram, do not wear deodorant or powder.  The Every Woman Matters program recommends that you get a mammogram every year if you are 50 years of age or older and every 1-2 years if you are between the ages of 40-49.

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What is a Breast Self-Exam (BSE)?

Breast self-exam is when you check your breasts yourself for breast lumps.  You want to become familiar with how your breasts feel and look.  It is recommended that you do a BSE every month after your period.  The Every Woman Matters program pays for your health care provider to teach you BSE at your regular screening appointment. If you have changes in your breasts, tell your health care provider.  You can also ask your clinic or provider for breast self-exam information to take home with you.

If you have been through menopause, you should check your breasts on the same day of every month.  Choose any day that you can easily remember, and do it each month on that day.

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What if I have cancer or pre-cancer of the breast or cervix?

Every Woman Matters does not cover treatment for cancer or pre-cancer of the breast or cervix. Women diagnosed through Every Woman Matters after September 1, 2001 are eligible for treatment services through Medicaid.   You must contact EWM to access these treatment services.  You cannot get treatment services for cancer or pre-cancer directly through Medicaid.

Many women screened and diagnosed with a breast or cervical cancer or pre-cancer will be eligible for Medicaid coverage.  Women entering Medicaid are eligible for coverage for the duration of their treatment.  You must be a resident of Nebraska and have a Social Security Number (SSN) to qualify for treatment.

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What is Heart Disease?

Heart disease is also known as cardiovascular disease.  Heart disease is any disorder that affects the heart’s ability to function normally. The most common cause of heart disease is narrowing or blockage of the coronary arteries, which supply blood to the heart itself. This happens slowly over time. If a person has high blood cholesterol or high blood pressure this may cause heart disease.

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What is High Blood Pressure?

Blood pressure is the force of the blood pushing against the walls of the arteries. Each time the heart beats (about 60-70 times a minute at rest), it pumps out blood into the arteries. When high blood pressure is not found and treated, it can cause many problems, including the heart getting larger and heart failure.   

Small bulges can also form in blood vessels.  Common locations are the main artery from the heart (aorta), arteries in the brain, legs, and intestines, and the artery leading to the spleen. If high blood pressure is not found and treated it can also cause blood vessels in the kidney to narrow which may cause kidney failure.  

Arteries throughout the body “harden” faster, especially those in the heart, brain, kidneys, and legs. This can cause a heart attack, stroke, kidney failure, or the need for amputation of part of the leg. The optimal blood pressure would be 120/80.

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What is Diabetes?

Type 1 diabetes: Usually first diagnosed in children or young adults.  In this form of diabetes, the immune system attacks the cells that make insulin in the pancreas and destroys them.  The pancreas then makes little or no insulin, and cells can’t take sugar from your blood.  Someone with type 1 diabetes takes insulin shots or uses an insulin pump. 

Type 2 diabetes: The most common form of diabetes.  People can develop it at any age - even during childhood.  Type 2 diabetes begins when your body can’t use insulin properly, and there is too much sugar in your blood.  At first the pancreas keeps up with the added demand by making more insulin.   Over time it can’t make enough insulin.

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What is Cholesterol?

Cholesterol is a waxy, fat-like substance that is found in all cells of the body. Your body needs some cholesterol to work the right way. Cholesterol is also found in some of the foods you eat. You use cholesterol to make hormones, Vitamin D, and substances that help you digest foods. The optimal TOTAL cholesterol level to have would be less than 200.

Blood is watery and cholesterol is fatty. Just like oil and water, the two do not mix. So, in order to travel in the bloodstream, cholesterol is carried in small packages called lipoproteins (lip-o-PRO-teens). The small packages are made of fat (lipid) on the inside and proteins on the outside. Two kinds of lipoproteins carry cholesterol throughout your body. It is important to have healthy levels of both:

LDL (low density lipoprotein) cholesterol is sometimes called “bad” cholesterol.
High LDL cholesterol leads to a buildup of cholesterol in arteries.

• The higher the LDL level in your blood, the greater chance you have for getting heart disease. The optimal LDL cholesterol level to have would be less than 100.
• HDL (high density lipoprotein) cholesterol is sometimes called “good” cholesterol.
• HDL carries cholesterol from other parts of your body back to your liver.

The liver removes the cholesterol from your body. The higher your HDL cholesterol level, the lower your chance of getting heart disease. The optimal HDL cholesterol level to have would be greater than or equal to 40.

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What is a Colposcopy?

A colposcopy is the most common test for women who have had one or more abnormal Pap test results.  The exam can be done in 15 to 30 minutes in the office or clinic by a health care provider who has the experience and necessary equipment. It is a special exam that takes a closer look at your cervix (the lower narrow end of the uterus or womb).

The health care provider uses a colposcope to view your cervix along with a speculum, the same instrument used to widen the opening of your vagina during your Pap tests. The colposcope is a magnifying glass with a bright light in it. During the test you might feel nothing at all or a mild tingling. Diluted white vinegar is put on the surface of the cervix. Areas that are abnormal turn white from the vinegar and can be seen more easily. If abnormal cells are seen, a sample of the cells (biopsy) will be taken.  The cells are sent to a lab for closer study. You might feel a little pinching or cramping during the biopsy.   Your health care provider may suggest taking a Tylenol or a similar medication 30 to 45 minutes before the exam.  Be sure to discuss with your health care provider the instruction you need to take home with you. Depending on the results, your health care provider may want to discuss treatment choices with you.

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Why should I be screened for Colon Cancer?

Colon cancer is a disease of the lower bowel or colon. Frequently there are no signs or symptoms of colon cancer.  When abnormal growths in the colon are found early and removed, the disease is preventable.  

The American Cancer Society recommends that all men and women over 50 years of age be screened for colon cancer. Discuss this test with your health care provider when you have your annual breast and cervical and cardiovascular health screenings. For more information, please visit the Nebraska Colon Cancer Screening Program.

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What is a Fecal Occult Blood Test (FOBT)?

A test that checks for hidden blood in the stool.  At home, using a small stick from a test kit, you place a small amount of your stool, from three different bowel movements three days in a row, on test cards.  You return the cards to your doctor’s office or a lab, where they’re checked for blood.  This test is recommended yearly.  If blood is found, you will need a follow-up colonoscopy.

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What is a Flexible Sigmoidoscopy?

Before this test, you use a strong laxative and/or enema to clean out the colon.  Flexible sigmoidoscopy is conducted at the doctor’s office, clinic, or hospital.  The doctor uses a narrow, flexible, lighted tube to look at the inside of the rectum and the lower portion of the colon. During the exam, the doctor may remove some polyps (abnormal growths) and collect samples of tissue or cells for more testing.  This test is recommended every 5 years.  If polyps are found, you will need a follow-up colonoscopy.

Having both of the above tests together increases the chances of finding polyps and cancers.  When used together, FOBT is recommended yearly and a flexible sigmoidoscopy is recommended every 5 years.

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What is a Colonoscopy?

Before this test, you will take a strong laxative to cleanse the colon. Colonoscopy is conducted in a doctor’s office, clinic, or hospital.  You are given a sedative to make you more comfortable, while the doctor uses a narrow, flexible, lighted tube to look inside the rectum and the entire colon.  During the exam, the doctor may remove some polyps and collect samples of tissue or cells for more testing.  This test is recommended every 10 years.

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What is a Double Contrast Barium Enema (DCBE)?

This test is conducted in a radiology center or hospital.  Before the test, you use a strong laxative and/or enema to clean out the colon.  This procedure involves taking x-rays of the rectum and colon after you are given an enema with a barium solution, followed by an injection of air.  The barium coats the lining of the intestines so that polyps and other abnormalities are visible on the x-ray.  This test is recommended every 5 years.

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For more information, contact:
Office of Women's Health
Every Woman Matters
301 Centennial Mall South, 3rd Floor
P.O. Box 94817
Lincoln, NE 68509-4817
In Lincoln:  (402) 471-0929
Outside Lincoln:  (800) 532-2227
Fax: (402) 471-0913 or (402) 742-2379
TDD: (800) 833-7352
E-mail: every.woman.matters@dhhs.ne.gov

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