The Connecticut Radiological Society and women’s health advocates looked for a positive response from Democratic Gov. Dannel P. Malloy this week after securing overwhelming bipartisan legislative support that led to the May 5 passage of HB 5233, a bill that mandates insurance coverage of digital breast tomosynthesis (DBT) in the state.
The bill faced the governor’s possible veto as of May 12 because of cost concerns, despite passing the House 139-3 and Senate 36-0. The state Insurance Department estimated that mandated DBT coverage would cost $9.2 million in fiscal 2017 and $10 million in fiscal 2018. House Republican leader Themis Klarides and other supporters have challenged the accuracy of those figures.
HB 5233 itself expands Connecticut’s current statute mandating insurance coverage of breast cancer screenings to include DBT as an option in addition to a baseline mammogram for any woman who is 35-to-39 years old and for annual breast screenings beginning at age 40.
Despite a possible veto, the Connecticut Radiological Society highlighted the HB 5233’s passage as an important step forward in care of patients, especially women with dense breast tissue. DBT helps address the problem of overlapping tissues in planar full-field digital mammography and improves image interpretation accuracy. Practices that offer DBT make a significant financial investment in additional equipment, work stations and digital storage solutions to provide the service, however.
On the federal level, the Centers for Medicare and Medicaid Services, added reimbursement for Medicare patients receiving DBT beginning in January of 2015, but some large private payers still consider DBT to be investigational. As reported in the May 6 issue of Advocacy in Action, the American College of Radiology’s Commission on Breast Imaging and Commission on Economics recently sent a letter to Anthem Blue Cross Blue Shield asking the insurers to grant routine DBT coverage.
The ACR provides a resources page to assist members in approaching payers to request coverage. The College also continues to support its 2014 position statement on DBT technology.
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