Provides health insurance coverage for a follow-up ultrasound for breast cancer screening upon the recommendation of a physician

Some women, however, are discovering that follow-up visits for digital mammograms or ultrasound procedures are not covered by their health insurance. While notification is a good first step in improving the screening for breast cancer, ensuring that necessary follow-up screenings are covered by health insurance is similarly necessary.

Summary of provisions

Section 1 of the bill amends section 3216 of the insurance law in relation to coverage for a follow-up ultrasound, in the event that a physician determines that a covered person has extremely dense or heterogeneously dense breast tissue.

Section 2 of the bill amends section 3221 of the insurance law in relation to coverage for a follow-up ultrasound, in the event that a physician determines that a covered person has extremely dense or heterogeneously dense breast tissue.

Section 3 of the bill amends section 4303 of the insurance law in relation to coverage for a follow-up ultrasound, in the event that a physician determines that a covered person has extremely dense or heterogeneously dense breast tissue.

Section 4 of the bill is the effective date.

Justification

The relation between dense breast tissue and cancer risk is immense. Women with dense breasts have been shown to have a four- to six- fold increased risk of developing breast cancer. Extremely dense breasts are not uncommon. In the U.S., ten-percent of women are classified as having extremely dense breasts.

Breasts consist of a mixture of fibrous and glandular tissue and fatty tissue. Breasts are considered dense if they have a lot of fibrous and glandular tissue but not much fat.

On a mammogram, dense tissue appears white. Both benign and cancerous lumps also appear white. Therefore, mammograms are less accurate for women with dense breast tissue. Breast tissue density is classified by radiologists using a four level density scale. This scale ranges from almost entirely fatty, to scattered areas of fibro glandular density, to heterogeneously dense and to extremely dense. Only ten-percent of women have almost entirely fatty breast. Therefore, ninety-percent of women are at risk of an inaccurate mammogram.

Studies have shown that for women with dense breast tissue, ultrasound and magnetic resonance imaging (MRI) are more accurate tests for detecting breast cancers than a mammogram. Ultrasound and MRI technology can find breast cancers that cannot be seen on a mammogram. An ambiguous mammogram will result in the recommendation of a further evaluation using ultrasound and magnetic resonance imaging (MRI) by one's doctor. The issue is that said further evaluation, which is necessary to detect cancer, is often not covered by one's insurance.

In 2012, legislation was passed by New York mandating that women who undergo a mammogram must be informed by their doctor if the test indicates that they have dense breast tissue. This notification will result in a follow-up evaluation. However, many women have found that these follow up procedures are not covered by their health insurance. Although this notification is very helpful, it is essential that the resulting necessary follow-up procedures be covered by a woman's health insurance. Ensuring this coverage will undeniably save lives.

Bill history

2014: A.8210

Fiscal implications

This bill will increase the number of individuals covered by health insurance for follow-up ultrasound and magnetic resonance imaging (MRI) procedures to detect breast cancer.

Effective date

This act shall take effect on the sixtieth day after it shall have become a law and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such date.