It’s time for all women to have 3-D mammography coverage
Ihad my annual mammogram a few weeks ago and was dismayed to learn some insurance companies — including the national payer Humana — still are holding out on covering three-dimensional mammography for detecting breast cancer, despite studies that show the latest technology detects 41 percent more invasive cancers and reduces unnecessary, and stressful, callbacks by 40 percent.
Currently 78 percent of insured U.S. women have coverage, according to a spokeswoman for Marlborough, Massachusettsbased Hologic, which manufactures a version of the cutting-edge technology. Hologic continues to advocate for coverage for all women, she said.
Medicare has covered 3-D mammography, or digital breast tomosynthesis, since Jan. 1, 2015. Cigna was the first national payer to begin covering it late last summer. Anthem became the second in January and United followed in February. Currently, 28 Blue Cross Blue Shield plans, including Blue Cross and Blue Shield of Oklahoma, cover it.
If their insurers don’t cover it or apply it to their out-of-pocket deductibles, patients at the Edmond office of OU Medicine’s Breast Health Network may pay as much as $135 out of pocket for 3-D mammography. Thankfully, my technologist, Jessica, said most opt for 3-D regardless.
In a story I wrote five years ago on 3-D, one Oklahoma City radiologist compared a 3-D image with a loaf of raisin bread, with the ability for doctors to scroll through and pick up raisins, or micro calcifications, in each layer or slice. If radiologists find cancers when they’re micro calcifications, cure rates rise significantly, he said, noting 3-D especially is beneficial to women with dense or soft tissue.
Connecticut, Illinois, Pennsylvania and New York now mandate coverage for breast tomosynthesis, with Texas and Arkansas soon to follow. Meanwhile, Arizona, Maryland, Missouri, New Jersey and New Hampshire are pursuing similar legislation.
According to the Los Angeles-based journal “Law 360,” at least one patient, California breast cancer survivor Darla Moe, decided to fight for all women through the courts, suing her insurer, Anthem Blue Cross, because the company denied coverage on 3-D mammograms in 2014 and later. When contacted last week, Moe said she couldn’t comment on the case because she’s now in mediation with Anthem.
The journal reported in February that Moe’s doctor recommended 3-D, but Anthem denied her coverage, saying the procedure was merely investigational and not medically necessary, even after a California Department of Insurance board ruled the higher grade mammogram should have been done.
Under the Affordable Care Act, or Obamacare, mammograms, as annual preventive screenings, are supposed to be covered with no cost sharing. Yet thousands of women whose insurance companies don’t yet cover it are having to decide whether to pay extra for the latest 3-D mammogram or risk having breast cancer that goes undetected.