Insurers to Cover Mammogram

Witnesses Support Bill Requiring Insurers To Cover Mammogram Procedure

From Gongwer News Service, www.gongwernews-oh.com, October 3, 2017

Doctors and provider groups urged a Senate panel Tuesday, October 3, 2017 to back a bill that would require insurers to cover a new form of mammogram as a way to assist in the detection of breast cancer.  Victor Goodman, representing the Ohio State Radiological Society, told the Senate Insurance and Financial Institutions Committee that the state has required insurers to cover screening mammography since 1997. The bill (SB 121) would require insurers to cover tomosynthesis as part of breast cancer screenings.  He predicted opponents would likely say the bill imposes a new coverage mandate on insurers, but the General Assembly in the past acknowledged that new technology would be developed for mammography.  “This is not a new mandate,” he said. “It’s something that’s been part of the Ohio Revised Code essentially since 1997.”

Dr. Bang Huynh, a radiologist with Columbus Radiology from Grant Hospital, said the tomosynthesis process, also known as 3D mammography, has improved detection rates. “The reason cancer detection is so important is the earlier we are able to detect it, the better we are able to treat the patient,” he said.  Sen. Bob Hackett (R-London) asked if the 2D mammography is always done first.  Dr. Huynh said some places only do the 3D image and then synthesize the images to a single 2D image.  “You don’t have the option of deciding after you do the 2D whether to do the tomo or not,” he said. Any subsequent test would be a diagnostic test, not a screening test covered as preventive care.

Sen. Dave Burke (R-Marysville) said the General Assembly would be legislating how a procedure should happen at a physician’s office.  Dr. Huynh said he didn’t think of the bill as mandating what is being done in a doctor’s office.  “I don’t really see how this would force anybody to do anything that’s against their interests,” he said.  Sen. Burke asked why an insurer would deny someone a procedure that could be potentially beneficial.

Dr. Huynh said until recently a lot of insurers were not covering tomosynthesis.  “I would ask them, why would you not cover something that could be beneficial to patients?” he said.  Camille Grubbs, with Hologic, a manufacturer of breast tomosynthesis technology, said the technology is no longer considered experimental or investigational.

Judy Brandell, a nurse navigator at Mercy Health Fairfield Hospital, said in written testimony that insurance coverage of tomosynthesis and 3D mammography can be confusing for patients.  “Women are often confused and intimidated by their insurance coverage and the changes from year to year,” she wrote. “So if the technologists and nurses don’t know for sure if they are covered, they end up declining due to potential additional and unknown costs. From my perspective, it’s especially frustrating that the younger age range, who more frequently have dense and sometimes extremely dense breast tissue, will decline due to the inconsistency of coverage.”

The Ohio State Medical Association, Ohio Society of Radiologic Technologists, Ohio State University Medical Center and OhioHealth offered written testimony in support of the bill.

 

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