health

Pa. mandates 3-D mammogram coverage

Marie McCullough, Inquirer Staff Writer

Updated: Tuesday, October 6, 2015, 1:08 AM

Women in Pennsylvania who undergo breast cancer screening with the latest advance, three-dimensional mammography, will not be charged extra for it.

Gov. Wolf's office announced a new policy Monday under which insurers must cover all screening mammograms, including the 3-D versions, at no out-of-pocket cost to consumers.

Three-dimensional mammography, also known as tomosynthesis, was approved in the U.S. in 2011 for use in combination with standard two-dimensional imaging. The dual approach is catching on, bolstered by rigorous research that shows 2-D plus 3-D increases breast cancer detection while reducing false alarms. Although the radiation dose is doubled, it remains below safety limits and can be reduced even further with the newest computer software.

Tomosynthesis addresses mammography's primary limitation: When the breast is squashed, overlapping tissue can hide tiny malignancies while making normal structures appear suspicious.

Some insurers still consider 3-D to be experimental and don't automatically cover it. But last year, the American College of Radiology declared it is no longer investigational. This year, Medicare began covering 2-D plus 3-D, reimbursing an extra $56 over 2-D alone, according to the radiologists' group.

The Pennsylvania Insurance Department has received complaints from "many" consumers regarding charges for tomosynthesis, according to Monday's announcement. Some women said their breast imaging center offered them 3-D for an extra $50 to $60; other women said they were not given a choice, then received a "surprise bill for the additional fee."

Insurance department spokesman Ron Ruman said he did not know whether any other states had mandated 3-D coverage at no extra cost to consumers.

In New Jersey, coverage varies, but insurers may consider 3-D necessary for women with certain breast cancer risk factors, such as extremely dense breasts, according to the state's insurance department.

At Independence Blue Cross, the biggest health insurer in Southeastern Pennsylvania, vice president Don Liss said the company had "a long-standing commitment to providing preventative health services for women."

"We will offer 3-D mammograms to our members in accordance with the Pennsylvania law," he wrote in a email.

Not all imaging centers pass on the costs of 3-D mammograms, even though a tomosynthesis system is about a $400,000 investment and radiologists must review more images for each patient. The University of Pennsylvania, which has been researching the technology for more than a decade, does not charge patients or insurers extra.

"We have felt investing in tomosynthesis was 'the right thing to do' irrespective of the reimbursement," radiologist Emily F. Conant, chief of breast imaging at Penn, wrote in an email.

Tomosynthesis (tomo is Greek for slice) acquires a set of images from an X-ray tube that sweeps over the breast; a computer algorithm creates a 3-D reconstruction instantly. Both 2-D and 3-D images can be acquired with a single breast compression, so the patient perceives no difference.

mmccullough@phillynews.com

215-854-2720@repopter

Marie McCullough, Inquirer Staff Writer

Read full story: Pa. mandates 3-D mammogram coverage

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