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Ohio Bill on Tomosynthesis Coverage Receives Statehouse Hearing

Ohio Senate Bill 121, which would include tomosynthesis in the definition of screening mammography for insurance purposes, received its second hearing in the Senate Financial Institutions and Insurance Committee recently.  Below is an article that was included in a statehouse news publication, Gongwer, summarizing the hearing and the support the OSRS received from the medical community.  No additional hearings have been scheduled.  Let Chairman Hottinger know how tomosynthesis impacts your patients and ask for passage of Senate Bill 121.

Tuesday, October 3, 2017

Witnesses Support Bill Requiring Insurers To cover Mammogram Procedure

Doctors and provider groups urged a Senate panel Tuesday to back a bill that would require insurers to cover a new form of mammogram as a way to assist in the detection of breast cancer.

Victor Goodman, representing the Ohio State Radiological Society, told the Senate Insurance and Financial Institutions Committee that the state has required insurers to cover screening mammography since 1997.  The bill, SB 121, would require insurers to cover tomosynthesis as a part of breast cancer screenings.

He predicted opponents would likely say the bill imposes a new coverage mandate on insurers, but the General Assembly in the past acknowledged that new technology would be developed for mammography.

“This is not a new mandate,” he said.  “It’s something that’s been part of the Ohio Revised Code essentially since 1997.”

Dr. Bang Huynh, a radiologist with Columbus Radiology from Grant Hospital, said the tomosynthesis process, also known as 3D mammography, has improved detection rates.

“The reason cancer detection is so important is the earlier we are able to detect it, the better we are able to treat the patient,” he said.

Senator Bob Hackett (R-London) asked if the 2D mammography is always done first.

“You don’t have the option of deciding after you do the 2D whether to do the tomo or not,” he said.  Any subsequent test would be a diagnostic test, not a screening test covered as preventative care.

Senator Dave Burke (R-Marysville) said the General Assembly would be legislating how a procedure should happen at a physician’s office.

Dr. Huynh said he didn’t think of the bill as mandating what is being done in a doctor’s office.

“I don’t really see how this would force anybody to do anything that’s against their interests,” he said.

Senator Burke asked why an insurer would deny someone a procedure that could be potentially beneficial.

Dr. Huynh said until recently a lot of insurers were not covering tomosynthesis.

“I would ask them, why would not cover something that could be beneficial to patients?” he said.

Camille Grubbs, with Hologic, a manufacturer of breast tomosynthesis technology, said the technology is no longer considered experimental or investigational.

Judy Brandell, a nurse navigator at Mercy Health Fairfield Hospital, said in written testimony that insurance coverage of tomosynthesis and 3D mammography can be confusing for patients.

“Women are often confused and intimidated by their insurance coverage and the changes from year to year,” she wrote.  “So if the technologists and nurses don’t know for sure if they are covered, they end up declining due to potential additional and unknown costs.  From my perspective, it’s especially frustrating that the younger age range, who more frequently have dense and sometimes extremely dense breast tissue, will decline due to the inconsistency of coverage.”

The Ohio State Medical Association, Ohio Society of Radiologic Technologists, Ohio State University Medical Center and OhioHealth offered written testimony in support of the bill.



Rachel WinderOhio Bill on Tomosynthesis Coverage Receives Statehouse Hearing
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