Requires health insurance policies to cover comprehensive ultrasound screening and magnetic resonance imaging for breast cancer in certain cases

BILL NUMBER:S8488

Title of bill

An act to amend the insurance law, in relation to requiring health insurance policies to cover comprehensive ultrasound screening and magnetic resonance imaging for breast cancer in certain cases and requiring the provision of certain information relating to breast density to patients

Purpose

This bill requires health insurance policies to provide additional coverage for comprehensive ultrasound screening and/or magnetic resonance imaging (MRI) examination of an entire breast or breasts if a mammogram demonstrates dense breast tissue. It also requires specific written notification to the patient of the availability of such additional tests.

Summary of provisions

Section one amends paragraph 11 of subsection (i) of section 3216 of the Insurance Law by adding a new subparagraph (D) which specifies that insurance policies provide coverage for comprehensive ultrasound screening and/or magnetic resonance imaging (MRI) if a mammogram demonstrates dense breast tissue, or if a woman is believed to be at increased risk for breast cancer due to family history, prior personal history, positive genetic testing or other indications of breast cancer.

This new section also requires that each mammography report provided to a patient include information about breast density and the availability of supplemental comprehensive ultrasound screening for breast cancer.

In addition, it provides that such additional coverage may be subject to annual deductibles and coinsurance as may be deemed appropriate by the superintendent and as are consistent with those established for other benefits within a given policy.

Section two amends paragraph 11 of subsection (1) of section 3221 of the Insurance Law by adding a new subparagraph (D) to read exactly the same as section one above.

Section three amends subsection (p) of section 4303 of the Insurance Law by adding a new paragraph (4) to read exactly the same as section one above.

Section four amends paragraph 7 of subsection (d) of section 4326 of the Insurance Law, as added by chapter 1 of the laws of 1999 by adding a cross reference to subsection (p) of section 4303 of the Insurance Law.

Section five provides that this act shall take effect on the sixtieth day after it shall have become a law.

Existing law

Currently, the decision to refer a patient for a follow up ultrasound screening or an MRI subsequent to a mammogram which reveals dense breast tissue is discretionary with the physician. Many times the patient is not even aware of the fact that she has dense breast tissue.

Justification

Breast cancer is the most frequently diagnosed cancer among women. Cancer is five times more likely in women with dense breast tissue.

Mammograms can miss up to 40% of tumors present in dense breast tissue as denser tissue tends to obscure tumors. Ultrasound screening and/or an MRI examination after a mammography that reveals dense breast tissue can help doctors discern the presence of a tumor when mammograms leave questionable results.

Post mammogram written notification to patients with dense breast tissue will keep patients informed. Raising awareness of breast density is very important. Assisting physicians and patients in the detection of early stage cancers serves to make them more treatable.

The State of Connecticut has already enacted this law. The States of Florida, California, and Texas are in the process of considering it.

Legislative history

New bill.

Fiscal implications

None.

Local fiscal implications

None.

Effective date

This bill takes effect on the sixtieth day after it shall have become a law.