A mammography technician talks about the process of receiving yearly mammograms and early detection of breast cancer in this file photo. A new Pennsylvania law requires insurers to cover breast MRIs and ultrasounds for women with very dense breasts and other high-risk factors for breast cancer.
File photo
Applies to women with dense breasts, other high-risk factors for breast cancer
Amid all the other political stories this year, some health-related news out of Harrisburg this summer might have escaped many people’s attention.
In July, Gov. Tom Wolf signed into law Senate Bill 595, a piece of legislation that requires insurers to cover breast MRIs and ultrasounds for women with very dense breasts and other high-risk factors for breast cancer.
The legislation was sponsored by state Sen. Bob Mensch, R-Berks, Bucks and Montgomery counties, and was unanimously passed by both houses before being sent to Wolf for his approval.
According to the Pennsylvania Breast Cancer Coalition, for women with very dense breasts and/or other high-risk factors, a mammogram may not be enough to detect a lump or irregularity in the breast. Breast MRIs and ultrasounds are often necessary to provide accuracy, but some insurers did not cover those screenings, the PBCC noted.
The new legislation requires insurance coverage of MRIs and ultrasounds for women with:
• Extremely dense breast tissue.
• High-risk factors for breast cancer such as a personal history of breast cancer, a family history of breast cancer or a genetic predisposition.
• Heterogeneously dense breast tissue and one other high-risk factor.
“This is a great victory for the women of Pennsylvania and the families that love them. We salute Governor Tom Wolf for signing SB 595, legislation we know will save women’s lives or greatly improve women’s lives by providing affordable access to the early detection of breast cancer,” said PBCC President and Founder Pat Halpin-Murphy. “We are now on the forefront of states across the country requiring insurers to cover breast MRIs and ultrasounds that women need. Thank you, chief sponsor Sen. Bob Mensch for your dedication to this bill and thank you, Governor Wolf, for taking this historic action!”
Under the law, the patient may be responsible for normal costs such as co-pays, co-insurance and/or deductibles based on the individual’s health insurance policy, the PBCC noted.
Also, it applies only to insurance companies that issue policies covered under Pennsylvania law, and implementation dates vary depending upon the patient’s particular insurance plan.
“Medical advancements have brought greater peace of mind to many women suffering from breast cancer,” Mensch said in a quote released by the PBCC.
“Over the years, insurance coverages have been working to keep pace with these advancements to ensure the best possible outcomes for breast cancer victims,” Mensch added. “Senate Bill 595 brings the medical community and the insurance community even closer together to provide better coverage, and to hopefully provide greater health, comfort and peace of mind to those suffering with this disease. Solutions are within our grasp, and Senate Bill 595 makes these potentials an even greater reality.”
