Bill to require insurers to pay for additional breast cancer screenings about to become law in Pennsylvania
A bill that would require insurance companies to provide ultrasound or magnetic resonance imaging coverage for women at increased risk for breast cancer is about to reach Governor Tom Wolf.
The governor said he would sign it into law.
The legislation, sponsored by Senator Bob Mensch, R-Montgomery County, would make Pennsylvania one of the few states that require insurers to cover the high cost associated with these additional screenings for women with the following criteria:
- A personal or family history of breast cancer or a genetic predisposition to it;
- Extremely dense breast tissue;
- Dense heterogeneous breast tissue with another high risk factor for breast cancer.
MRIs and ultrasound, with their clearer imaging, can detect breast cancer better than a mammogram, because the cancer and density appear white on a mammogram. But MRIs and ultrasound can get expensive.
Ruth Gunnett, of Southampton Township, Franklin County, can attest to the cost.
Having dense breast tissue as well as a family history, Gunnett, 36, said her doctor initially recommended that in addition to her annual mammogram, she undergo an MRI every two years as a preventative measure. She followed her doctor’s advice and had an MRI. The bill for this additional screening was almost $ 4,000. Her insurance company said she would be responsible for paying her.
“After my first bill, I told my doctor, uh, you have to come up with a new plan because I can’t do it every two years,” Gunnett said. “I’m still paying for the one I had two years ago,”
Hearing that insurance companies in Pennsylvania will be required by this soon to be enacted state law to cover the cost of future MRI scans is a huge relief, she said.
It will help other people who have shared similar stories with her as the one she had. It will also help her younger sister and two daughters, who have a family history of breast cancer from both herself and her husband.
“I’m ready to fight right now because they shouldn’t have to fight when the time comes to make sure they get these preemptive screenings,” Gunnett said. “I don’t want them to be afraid to get them and I don’t want them to have to decide if it’s something they can do financially. It’s something they should be doing.
That’s why she said she told her personal story in a video shared by the Pennsylvania Breast Coalition to help garner legislative support for Mensch’s Bill.
A recent study published in the Journal of the American Medical Association found that MRI scans can detect 2.5 times more breast cancer than 3D mammograms in women with dense breasts.
“It will help women who need an MRI or ultrasound find their breast cancer at an earlier stage that can be treated,” said Pat Halpin-Murphy, president and founder of the PA Breast Cancer Coalition. “When we say it’s important to diagnose early, it means you have a better chance of reducing the severity of side effects and side effects from treatment.”
Once the governor signs this bill, it will go into effect next year – and for some insurance policies, not until 2022.
In the meantime, Halpin-Murphy said the coalition will undertake a comprehensive education effort to ensure doctors know the law and can reassure patients about the potential cost of additional screenings if they are at high risk. breast cancer.
Mensch, the godfather of Bill, was a crusader for strengthen breast cancer detection efforts through the legislative process of the past decade. He is the author of a 2014 law that requires women to receive breast density results as part of their mammogram results.
“Women who have extremely dense breast tissue are four to six times more likely to develop breast cancer,” he said in remarks in the Senate Wednesday urging his colleagues to support the legislation. He said mammography tests to detect cancer failed to detect tumors 40% of the time in women with extremely dense breast tissue.
“I am convinced that this legislation will make a difference in the lives of many people affected by this terrible disease,” he said.
The bill was passed unanimously by the House and the Senate.
* This story has been updated to provide more details on when this legislation came into force.
Jan Murphy can be reached at [email protected]. Follow her on Twitter at @JanMurphy.
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