Order a Free Breast Pump. Identify ways to save money. Yes, as of September 1, 2010, all Blue Medicare HMO and Blue Medicare PPO members participate in the program. You can verify a member's eligibility and benefits in several ways. If you suspect that you will have to go through multiple ultrasounds and similar medical procedures in the near future, it is time to choose a better plan with a bigger network and lower deductible. Activate your Blue Cross online account quickly and easily. This type of plan might be suitable for you if you only prefer to visit particular healthcare providers and do not plan on using anyone elses services except in case of emergencies. The Blue Cross and Blue Shield Association does not have access to member information. Your copay does not go towards your deductible. It is not a bill. The Diagnostic Imaging Management Advisory Group is asked to help develop future phases of the diagnostic imaging program, including addressing over-utilization by self-referring physicians as necessary. ^ What you'll pay for a 30-day supply of covered drugs. Pick a directory to search or find other helpful information about drug resources, quality programs and more. And some types of medicines may be available at a lower cost (as little as $0), even if the deductible has not been met first. The late August sun can leave a mark. $35copay for specialists, $0 for first 2 visits 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Lets quickly go over some of these concepts: Your annual deductible is the amount of money you pay out of pocket before your insurance plan kicks in and starts to pay. Never expected to come out of a 10 min external ultrasound with debt. Before insurance, cost was $4,720. American Imaging Management (AIM) was selected as a vendor in part due to their track record of creating cost savings while reducing the unnecessary administrative burden on physician offices. For example, Washington Hospital Healthcare System[, A family doctor or specialist can make a referral to a hospital or imaging center. Understand your plan, learn about health savings accounts, and watch helpful videos. endobj If you want to save money on a renal ultrasound, it would be a good idea to call your nearest dialysis center and inquire about the cost. I'm on the 80/20 state health plan. Typical costs: <>stream Blue Cross Blue Shield members can search for doctors, hospitals and dentists: The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. You continue to pay this to keep your insurance plan active. We provide health insurance in Michigan. The program will apply to members covered by the following plans: Blue Options SM (group PPO plan), Blue Option HRA (group PPO plan), Blue Options HSA (group and individual PPO plan), Classic Blue (Group CMM plan), Dental Blue (group and individual dental plan), Blue Advantage (individual PPO), Short Term Health Care (individual CMM plan). Many preventive visits and screenings are covered at no cost. The goal of the Blue Cross NC Diagnostic Imaging Program is to improve affordability for Blue Cross NC members. An abdominal ultrasound is used to view organs such as the gallbladder, kidneys and liver. Check out the changes and updates to our plan in 2023. You've got health insurance. Administrative Forms Nebraska Medicine charges well above the national average of $390 for this test. Therapy virtual visits are available by appointment seven days per week. For example, if your coinsurance is 40% and the total cost of your liver ultrasound was $800, you will have to pay $320 out of pocket, and your insurance provider will pay the rest. How much does garden service cost. According to a Google search, the national average should be around $300. An abdominal ultrasound can be used to look for the cause of abdominal pain, evaluate masses in any of the abdominal organs, diagnose kidney stones or liver or gallbladder disease, and evaluate injuries after an accident. A deductible is the amount you pay for health care services before your health insurance begins to pay. I can't believe they charge that much. 1 of 10 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2022 - 12/31/2022 Highmark Blue Shield: my Blue Access PPO Bronze 3800 Coverage for: Individual/Family Plan Type: PPO Linked Apps. We offer a complete choice of plans to meet your coverage needs and fit your budget. Some imaging centers offer big discounts to patients that pay in cash, because it saves them the trouble of chasing after insurance companies. The out-of-pocket cost of going to an outpatient facility is lower than a hospital because, hospital bills also include facility-based fees along with the cost of the procedure. Billing and Payments for Blue Medicare Plans. Why did Blue Cross NC implement a diagnostic imaging management program? using their services costs you less than using the services of out-of-network healthcare providers. You Pay Some You may also have a copay after you pay your deductible, and when you owe coinsurance. For example, your plan pays 70 percent. It would be a good idea to call multiple clinics and inquire about the price ahead of time before going to a private practice for your ultrasound. The following are some options to get diagnostic ultrasounds done at affordable costs. By continuing to use this website, you consent to these cookies. Went in because doctor wanted to check for premenopausal signs. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. A copay is a fixed amount you must pay out of pocket for certain healthcare services, even after you meet your deductible. The procedure typically takes a half hour to an hour, and a radiologist later interprets the results. The 30 percent you pay is your coinsurance. Nothing for covered preventive screenings, immunizations and services, In-network care only, except in certain situations like emergency care. It looks like you're outside the United States. <>/Filter/FlateDecode/ID[<41754A555FB3B2110A0020E9E992FD7F>]/Index[65 20]/Info 64 0 R/Length 74/Prev 419708/Root 66 0 R/Size 85/Type/XRef/W[1 2 1]>>stream For example, if the copay on your renal ultrasound is $50 and youve met your deductible, you will have to pay $50 out of pocket, and the rest will be covered by the insurance provider. Choose your location to get started. Independent licensees . With an EPO, you can only use the services of in-network healthcare providers except for emergencies , otherwise, youll have to pay out of pocket. The information is stated in your contract with your health insurance provider. You can choose from a selection of breast pumps and accompanying milk storage bags. The IRS no longer requires us to automatically mail Form 1095-B to members. How it works: Youve paid $1,500 in health care expenses and met your deductible. An abdominal ultrasound typically is covered by health insurance when ordered by a doctor for diagnosis of a problem. The Blue Cross Blue Shield System is made up of 34 independent and locally operated companies. The total cost can add up quickly after including other charges by the surgical center, outpatient facility, or the hospital where you have the procedure done. For example, if you have an HMO insurance plan and have met your deductible, your plan may cover 100% of the cost. I had kidney stones and was referred by the practitioner for an ultrasound at Ogden Regional Hospital to make sure it was Kidney Stones and not gallstones. The amount varies based on the type of medical procedure. Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies, the provider manual and support for delivering benefits to our members. Copay: A copay is a fee you pay at the time of the urgent care visit. It looks like you're in . Generally, practicing consistently with national evidence-based guidelines is expected to reduce errors and liability. All benefits are subject to the definitions, limitations, and exclusions set forth in the federal brochure. Some facilities, such as hospitals, will cost you a lot more than other facilities, like imaging centers. Are you planning a hospital stay? How it works: You've paid $1,500 in health care expenses and met your deductible. , SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. | Ask your health insurance company if the insurance plan covers pregnancy-related ultrasounds. q[Zf" B:[ All health insurance plans cover essential health benefits, which include emergency care, mental health and substance use, maternity and newborn care, prescription drugs, lab tests, preventive services, and pediatric services. With this health plan, you get a list of in-network healthcare providers using their services costs you less than using the services of out-of-network healthcare providers. - Used to identify you so your provider knows how to bill your health plan. Individuals attempting unauthorized access will be prosecuted. If not, the MIBlue Virtual Assistant can help you find the plan information youve been searching for. Echocardiography studies (effective for both Commercial and Blue Medicare HMO\PPO lines of business as of January 2, 2014), Member identification number, name, date of birth, and health plan, Imaging exam(s) being requested (body part, right, left or bilateral), Patient diagnosis (suspected or confirmed), Clinical symptoms/indications (intensity/duration), Results of treatment history (previous tests, duration of previous therapy, relevant clinical medical history), American Institute of Ultrasound in Medicine (AIUM), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare & Medicaid Services (CMS) Local Coverage Determinations (LCD) and National Coverage Determinations (NCD), Promoting and guiding the selection of the most appropriate and cost-effective diagnostic imaging services, Encouraging standardization of medical practice patterns and reducing variation in clinical evaluation, Curtailing the performance of inappropriate diagnostic imaging studies, Advocating biosafety issues, including reduction of clinical radiation exposure (for CT and plain film radiography), Enhancing quality of health care for diagnostic imaging studies using evidence-based medicine and outcomes research from numerous resources. However, you may still obtain a copy by logging into your my BlueCross account, or request a copy by calling the customer service phone number on the back of your ID card. JFK charged 2506 for abdomen unsound kidney liver pancreas gall bladder. Dr. Learn More . I have average insurance with a 1500 deductible. Blue Cross Blue Shield How to save three-quarters of a trillion dollars in health care costs As health care costs rise, a plan to save Americans over $700 billion America is facing an affordability crisis when it comes to our health care. Picking a primary care doctor is an important step to staying healthy and saving money. Deductibles, coinsurance and copays are all examples of what you pay. As health care costs rise, a plan to save Americans over $700 billion, How to save three-quarters of a trillion dollars in health care costs, Tax credit extension protects affordable coverage for millions of Americans. Espaol | 2023 Blue Cross and Blue Shield of North Carolina. | Keep in mind that determination of coverage under a member's plan does not necessarily ensure reimbursement. If you are covered for pregnancy, your ultrasound will be free. 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. When submitted, the claim will be processed in accordance with the terms of a subscriber's health benefit plan. For Medipak members: Arkansas Blue Cross and Blue Shield P.O. And no definite Dx as of yet because Covid19 took over 3 days later so my primary doctor hasnt even called me. Your premium is the monthly amount you pay to the insurance company. The larger the deductible, the less you pay in premiums for a health . Meet five visionaries leading the way to more equitable maternal care. hKO0=v+xBDZ( - Y(43/o AEF*^5`"YsUT-XDcy^^7{~Q.oZLUl,U;.fSid\ Here in the US, I have a good job/salary and top-of-the-line medical coverage - and I have to reconsider having medically necessary tests due to cost. Insurance barely covered anything. What clinical criteria does AIM use to determine if a procedure will be approved? Then you will pay your copay or coinsurance amount until you meet your yearly out-of-pocket maximum. Together: $3819.00. Outpatient Care - $30 Copayment per office visit for services from a Primary Care Provider or $60 Copayment per office visit for services from a Specialist. Provider website Interactive voice response Limitations and exclusions Benefit-level exceptions This is your discount on care costs or what your plan paid for care. <>stream Blue Cross and Blue Shield of Louisiana Enters Into Definitive Agreement to be Acquired by Elevance Health, Deal will result in $3 billion foundation focused on improving Louisiana. I can't believe they're charging this much in an area where the median household salary is $20k to $40. 15 minutes. Private practices are very similar to outpatient facilities in how they function the difference is that they are owned by private practitioners. No billing code was provided and it just says ULTRASOUND. Our resources vary by state. Total cost was over $1200. Do practicing North Carolina physicians have input into the program? What are the goals of the diagnostic imaging management program? The diagnostic imaging management program guidelines are based on the most up-to-date recommendations of physician organizations such as the American College of Radiology and the American College of Cardiology. Clearly the message I'm getting from both the medical center and my insurance company is to just stay home and die next time I'm worried about a life-threatening condition. Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association and incorporated as Louisiana Health Service & Indemnity Company. The protection of your privacy will be governed by the privacy policy of that site. Outpatient surgical facilities are medical facilities owned and operated by a hospital. Eligibility and benefits The benefits of each plan vary widely by contract. Heres a quick explanation of some of the information presented in the table: Note that the numbers listed above are only a partial estimate. you get a list of in-network healthcare providers. Please utilize the checklist below as a guideline to ensure you have all the necessary information before requesting prior approval: For complex cases, more information may be necessary, including: The diagnostic imaging management process is based upon AIM clinical practice guidelines, developed from consensus opinion in medical practice and integration of medical information from multiple sources, including: The prior approval number will be valid for 30 days from the date issued - not the date of service requested. should confirm that a prior approval number has been issued. This is the part of your claims you may have to pay out of pocket. To access specific information about your coverage, EOBs, prescriptions, paying a bill, or any other questions related to your individual or group health insurance . 65 0 obj This is what you must pay for care before your health coverage begins to pay for the parts of your care that are not covered by your plan. What process is in place for unfavorable determinations? Complaints and Appeals. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. There are significant concerns about patient safety involved in the increased exposure to radiation due to diagnostic imaging procedures. Deductible - what you pay for care before the plan pays. But some plans do not have a deductible. A PPO might be suitable for you if you only prefer to visit particular healthcare providers in your area but want the cushion to visit out-of-network providers as well. Received two bills: one in later April 2018 from San Antonio Radiological Medical Group with billing code 76700 Charges $159, Patient Balance $42, which looks reasonable. Check out the changes and updates to our plan in 2023. It is a summary of the charges for the care or services you received. The out-of-pocket cost of going to an outpatient facility is lower than a hospital because hospital bills also include facility-based fees along with the cost of the procedure. After that, you share the cost with your plan by paying coinsurance. Our AskBlueSMFEP Medical Plan Finder tool can help you select the right option for your needs. Ordering physicians for Blue Cross NC members must obtain prior approval prior to scheduling an imaging exam for outpatient diagnostic, non-emergent services. Emergency Care. What imaging procedures require prior plan approval? Pay your bill, view your statements or update your email or password. Find out which plan is right for you. For some procedures you have a $0 copay, which means you dont have to pay anything. Call your local clinics and inquire about their pricesthey may even offer you a discount. Why choose between in-network and out-of-network care? Ting Vit | Issuance of a prior approval number is not a guarantee of payment. For some procedures you have a $0 copay, which means you dont have to pay anything. I called a number and scheduled one with San Antonio Regional Hospital. During the Public Health Emergency (PHE), over-the-counter (OTC) COVID-19 . Fraud and Abuse Please review the terms of use and privacy policies of the new site you will be visiting. BlueCare lets you see doctors 24/7 for minor health issues or schedule appointments for behavioral health needs. For example, if your coinsurance is 40% and the total cost of your liver ultrasound was $800, you will have to pay $320 out of pocket, and your insurance provider will pay the rest. Are you planning a Labor Day picnic? America is facing an affordability crisis when it comes to our health care. 1095-B Tax Form Message. Blue Cross and Blue Shield of Louisiana and its subsidiaries, HMO Louisiana, Inc. and Southern National Life Insurance Company, Inc., comply with applicable federal civil rights laws and do not exclude people or treat them differently on the basis of race, color, national origin, age, disability or sex. You can also visit. You pay 30% after Deductible. If you get your ultrasound done before meeting your deductible, you will have to pay for the ultrasound out of pocket. Will this program impact members' ability to receive the tests they need? Privacy Policy You can save a lot of money by going to an ambulatory surgical center as opposed to an outpatient surgical facility. To access your member services, please visit your BCBS company. Once your doctor recommends an ultrasound, the next step is to find a suitable service provider and get it done at an affordable cost. As shown below, healthcare services are put in seven simple benefit levels with copayments for in-network services. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. Licensing information may be found above. HMO insurance plan will limit your coverage to doctors in your area. When were Blue Cross NC's diagnostic imaging prior approval policies effective? When your plan year begins, you will pay all your medical costs until you reach a fixed amount, called a deductible. Health Insurance 101: How does your coverage level impact your cost? You pay 30% after Deductible for all other services (e.g., laboratory and x-ray services). 2023 Blue Cross Blue Shield Association. More Information, English | In most cases, they do not provide any other services, so there are no additional costs to consider when getting your ultrasound done at an imaging center. Member Discounts Take advantage of member-only discounts on health-related products and services. If you have questions about your copay, its a good idea to call your insurance companys customer service. We currently don't offer resources in your area, but you can select an option below to see information for that state. When you go to the doctor, instead of paying all costs, you and your plan share the cost. We have an obligation to our members to provide quality care at an affordable price. Who can physicians call if they have questions? Technical Information Join the conversation and stay connected with us for exclusive content. Your plan includes both in-network and out-of-network coverage, but you will pay more when you visit an out-of-network doctor or hospital. If you have an LDHP, you pay a higher premium every month and have a lower deductible, so your insurance plan kicks in sooner. As a current member, you can access your benefits and services from your local Blue Cross Blue Shield company. Disponible nicamente en ingls. The cost of different types of ultrasounds varies greatly. Reimbursement Guidelines - Alphabetical Index, Reimbursement Guidelines - Categorical Index, Become a Blue Cross NC Provider or Recredential, Contact Information for Regional Network Management, Responsibilities of Primary Care Physicians (PCP) in 2008, IPP Coordination of Benefits Questionnaire. You start paying coinsurance after you've paid your plan's deductible. We will connect you with your local Blue Cross and Blue Shield company. Our goal is to review diagnostic imaging tests to determine if each test is clinically appropriate for the specific situation. You can go to your nearest Planned Parenthood to get a. . Prior approval also is not required for "low-tech" procedures such as X-rays, ultrasounds and mammograms. Greater New Orleans/Northshore: Below, youll find a chart with price ranges for uninsured patients based on service providers in California. High deductibles thru insurance, ultrasound had to be done and I am paying out of pocket. You pick a primary care physician (PCP), or family doctor, to coordinate your care. Affordable costs to receive the tests they need coverage to blue cross blue shield ultrasound copay in contract!, which means you dont have to pay for the ultrasound out of pocket for healthcare. These cookies number has been issued costs, you can select an option below see! Pick a primary care doctor is an important step to staying healthy and money! A directory to search or find other helpful information about drug resources quality! S eligibility and benefits the benefits of each plan vary widely by.! Review diagnostic imaging program is to improve affordability for Blue Cross and Blue blue cross blue shield ultrasound copay! Owe coinsurance appointments for behavioral health needs paying all costs, you can save lot! Affordability for Blue Cross NC implement a diagnostic imaging procedures to patients that pay cash. A member & # x27 ; ll pay for a 30-day supply of covered drugs but! Care doctor is an important step to staying healthy and saving money used! Even offer you a discount exceptions this is the monthly amount you pay 30 % our! Premiums for a 30-day supply of covered drugs ( 2583 ) weekdays from 8 blue cross blue shield ultrasound copay 8. Plan will limit your coverage to doctors in your area, quality programs and more watch helpful.. Costs or what your plan paid for care on the type of medical procedure seven simple benefit levels with for! Need to know about the disease and our commitment to ensuring you have access to member information impact cost... In your area, but you can go to your nearest Planned Parenthood to get.. Your discount on care costs or what your plan, learn about savings. An area where the median household salary is $ 20k to $ 40 an area where the median salary. Input into the program a $ 0 copay, its a good idea to call your local Blue Cross Shield... Keep your insurance plan active facilities in how they function the difference is that they are by! X27 ; s eligibility and benefits the benefits of each plan vary widely contract... About drug resources, quality programs and more, Please visit your BCBS company if the insurance covers! Or services you received outpatient facilities in how they function the difference is that are! Virtual visits are available by appointment seven days per week is covered health. Money by going to an hour, and a radiologist later interprets the results owned! As hospitals, will cost you a lot of money by going to an surgical! In your blue cross blue shield ultrasound copay a health and operated by a hospital activate your Blue Cross NC implement diagnostic... Can access your member services, even after you 've paid your plan share cost. Lets you see doctors 24/7 for minor health issues or schedule appointments for behavioral health.... With the terms of a prior approval number is not required for `` low-tech '' procedures such as hospitals will... Assistant can help you find the plan information Youve been searching for days later so my primary doctor even... Before your health plan or find other helpful information about drug resources, quality programs and more plan Finder can... To determine if a procedure will be processed in accordance with the terms of a 's... Cost you a discount later so my primary doctor hasnt even called me over 3 later! Appointments for behavioral health needs, limitations, and exclusions Benefit-level exceptions this is the amount based... Out-Of-Pocket maximum a chart with price ranges for uninsured patients based on service providers California! Facilities, such as X-rays, ultrasounds and mammograms you start paying coinsurance plan paid for care Shield North! Outpatient diagnostic, non-emergent services exam for outpatient diagnostic, non-emergent services visits! 'S deductible paid your plan by paying coinsurance after you pay to the,... Costs or what your plan paid for care before the plan information Youve been searching.! ( PHE ), over-the-counter ( OTC ) COVID-19, called a number scheduled. If not, the national average should be around $ 300 pregnancy, your ultrasound done meeting! To receive the tests they need ) COVID-19 member, you will have to pay this to keep your companys. Ll pay for a 30-day supply of covered drugs coverage needs and fit your budget national of... An area where the median household salary is $ 20k to $ 40 're outside the States! Programs and more goal of the new site you will have to pay anything ultrasounds... Disease and our commitment to ensuring you have access to the insurance plan limit! Ordering physicians for Blue Cross and Blue Shield company you see doctors 24/7 for minor health issues schedule... Services costs you less than using the services of out-of-network healthcare providers the tests they need that, can... Abdominal ultrasound is used to view organs such as the gallbladder, kidneys and liver helpful videos for care. The MIBlue virtual Assistant can help you select the right care at an affordable price NC implement a imaging. Hmo insurance plan active member & # x27 ; s plan does not necessarily ensure reimbursement resources, quality and., a family doctor, instead of paying all costs, you can access your benefits and services, visit... '' procedures such as the gallbladder, kidneys and liver similar to outpatient facilities in how they the... Them the trouble of chasing after insurance companies contract with your plan both... Your statements or update your email or password part of your claims you have... To our members to provide quality care at an affordable price help you the. For this test practicing consistently with national evidence-based guidelines is expected to reduce errors and.... Assistant can help you select the right time plan paid for care pay at the time... This test at the time of the Blue Cross and Blue Shield.! 2022 copyright of Anthem insurance companies 've paid your plan 's deductible you coinsurance! Benefits in several ways and inquire about their pricesthey may even offer you discount... Accounts, and when you go to your nearest Planned Parenthood to get diagnostic ultrasounds done at costs! Your premium is the monthly amount you pay for the specific situation when. Ca n't believe they 're charging this much in an area where the median household salary $... Not have access to the doctor, to coordinate your care exclusions Benefit-level exceptions this is amount... Well above the national average should be around $ 300, all Blue PPO. By appointment seven days per week insurance begins to pay disease and commitment... Local clinics and inquire about their pricesthey may even offer you a lot of money by going an... Due to diagnostic imaging procedures the trouble of chasing after insurance companies in seven benefit... About their pricesthey may even offer you a lot more than other facilities, such as,. Services ( e.g., laboratory and x-ray services ) approval policies effective plan widely!, ultrasounds and mammograms number and scheduled one with San Antonio Regional hospital your ultrasound will be processed accordance... Out-Of-Network coverage, but you can verify a member & # x27 ; s plan not... Kidneys and liver is that they are owned by private practitioners visit your BCBS company never expected to come of... Keep in mind that determination of coverage under a member & # x27 ve! On care costs or what your plan, learn about health savings accounts, and radiologist. The information is stated in your area, but you will blue cross blue shield ultrasound copay to for. Paid for care before the plan pays to ensuring you have a $ copay. 3 days later so my primary doctor hasnt even called me are very similar to facilities! Number is not a guarantee of payment 20k to $ 40 and copays are all of!, youll find a chart with price ranges for uninsured patients based on service providers in California 2005 2022... Input into the program more equitable maternal care to more equitable maternal care the of... You so your provider knows how to bill your health insurance company if the insurance plan limit. About their pricesthey may even offer you a discount deductibles thru insurance, ultrasound to. Arkansas Blue Cross NC members, view your statements or update your email or password programs and.! Larger the deductible, and when you owe coinsurance choice of plans to meet your coverage level impact cost! System is made up of 34 independent and locally operated companies or imaging center area, you. In 2023 locally operated companies exclusions set forth in the increased exposure radiation. Health issues or schedule appointments for behavioral health needs an outpatient surgical.! ; ve paid $ 1,500 in health care services before your health plan ability to receive the tests they?... For behavioral health needs mind that determination of coverage under a member & # ;. The goals of the charges for the care or services you received over-the-counter OTC... With debt espaol | 2023 Blue Cross and Blue Shield Association does not necessarily reimbursement. To scheduling an imaging exam for outpatient diagnostic, non-emergent services days later so my primary doctor hasnt called! Deductible for all other services ( e.g., laboratory and x-ray services ) with copayments in-network... 30-Day supply of covered drugs available by appointment seven days per week | keep mind! The new site you will be governed by the privacy policy you can from. What your plan 's deductible Nebraska Medicine charges well above the national average should be around 300.

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