HARTFORD, CT — When they passed legislation last year, lawmakers thought that insurance companies would be responsible for covering the cost of 3D mammography, also known as tomosynthesis.
However, an Insurance Department memo advised insurance companies that tomosynthesis was not considered mammography, according to the United States Preventive Services Task Force, and does not have to be considered a preventive service.
That means insurance companies can ask a patient to share the cost of the procedure. If it were considered a preventative service, it would mean that there would be no cost-sharing by patients.
A handful of lawmakers are trying to correct the issue this year with legislation stating that tomosynthesis is mammography and does have to be covered as a preventative service. It also limits the cost-sharing for various types of breast imaging services to $20 per procedure.
House Minority Themis Klarides, R-Derby, said the bill before the Insurance and Real Estate Committee seeks to “resolve this dispute” and to “make it clear that under Connecticut statute tomosynthesis is a mammogram.”
According to medical professionals, the 3D technology is better at preventing false positives, and would prevent repeat mammograms.
The guidance issued last July by the Insurance Department says that “Breast tomosynthesis is not subject to the ACA requirement for no cost sharing and may be covered with a cost-sharing requirement for women of all ages.”
Insurance Commissioner Katharine Wade didn’t take a position on this year’s legislation seeking to reverse the guidance her department gave insurance companies.
She did comment that the provision in the bill to cap co-pays for breast ultrasounds and MRI’s “could lead to higher health insurance costs statewide because this could result in an increase in premium.”
She also expressed concern regarding the limitations for coverage for women ages 35 to 39.
“This legislation will restrict a woman’s access to mammograms and, in some cases, roll back coverage completely for women 35 to 30 years of age,” Wade warned lawmakers.
Jennifer Herz, counsel for the Connecticut Business and Industry Association, said by capping cost sharing for a service like tomosynthesis lawmakers are simply shifting the cost to another payment such as a premium, deductible, or co-insurance.
The Connecticut Association of Health Plans and the Connecticut Conference of Municipalities agreed. Both testified against the proposed legislation.
Dr. Jean Weigert, of the Radiological Society of Connecticut, said simply “breast tomosynthesis is a mammogram.”
She said many women have come to her office and decided on traditional mammograms after learning they will have to share the cost of a 3D mammogram. However, Weigert stressed there are fewer patient call backs with tomosynthesis because there’s less uncertainty with the image it provides.