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BY IRENE CARD AND BETSY CHANDLER
NEWJERSEYNEWSROOM.COM
YOUR HEALTH INSURANCE
Last week women across the country heard of a startling report that said women no longer need to get routine mammograms starting at age 40 and every year thereafter. A startling study by the U.S. Preventive Services Task Force on breast cancer screening published a report in the Annals of Internal Medicine recommending routine mammograms starting at age 50 and every two years thereafter.
The American Cancer Society's long standing position has been that women should get cancer-screening mammograms starting at age 40. Now what do we do? Will our health insurance cover a routine mammogram if we go every year?
Keep in mind, as you read this, that this entire article pertains to routine mammograms. If you are at high risk for breast cancer or have had a history of lumps, cystic or otherwise, a mammogram is not "routine" for you; it is diagnostic and insurance will always cover a diagnostic mammogram, so long as it is coded correctly. If you find a lump, make an appointment with your physician immediately. This is a medically necessary appointment and will be covered by your health insurance. Do not postpone seeing your physician because you had a mammogram less than a year ago.This Task Force made a recommendation; it was not a mandate. There is a huge difference between a recommendation and a mandate. The results of this controversial study garnered a lot of attention in the press. On the TV show, Good Morning America, Dr. Susan Love, a well-known and highly respected breast surgeon and book author on the subject of breast cancer went toe-to-toe with Dr. Marisa Weiss, a very well-known radiation oncologist whom I have had the pleasure of knowing. Dr. Weiss is a strong advocate of American Cancer Society guidelines.
Horizon Blue Cross Blue Shield of NJ came out with a report the day after the Task Force announced their findings. Horizon issued the following statement which you will find comforting if you are insured by Horizon: "Horizon BCBSNJ strongly supports and has for many years advocated mammography as the best screening tool for the early detection of breast cancer in order to keep women healthy and save lives. Our current medical policy for breast cancer screening will not change in light of the announcement of new guidelines from the U.S. Preventive Services Task Force. We will evaluate these new recommendations and seek out expert input before making any decision to change our current medical policy. We will continue to work with organizations we have supported over the years, including the American Cancer Society and Susan G. Komen for the Cure, to ensure our medical policy provides breast cancer screening coverage adequate to keep women healthy."
Currently, Horizon's medical policy provides coverage for one baseline mammogram examination for women between the ages of 35 to 39 years; an annual mammogram for women age 40 years and older; and in the case of a woman who is under age 40 years and has a family history of breast cancer or other breast cancer risk factors, a mammogram examination at such age intervals as the physician deems medically necessary.
Right after this Task Force announced their findings (and recommendations), Kathleen Sebelius, Secretary of U.S. Health and Human Services announced that women should keep getting regular mammograms starting at age 40. Medicare will pay for a routine annual mammogram starting at age 40 an over.
Women of all ages have to discuss this issue with their physician. The best decision for you will be made between you and your health care provider.
If your insurance carrier decides not to continue their current policy of paying for routine annual mammograms, they will give you plenty of notice if any changes in your contract.
Irene Card & Betsy Chandler are both licensed insurance professionals working at MIC Insurance Services, a health insurance services company. If you have questions relative to this column or other related topics, we invite you to call (973) 492-2828, browse our past columns on our web site at www.micinsurance.com.
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