News | Mammography | March 09, 2017

Solis Mammography Supports Texas Tomosynthesis Insurance Coverage Bill

HB1036 requires commercial providers to cover 3-D mammography

Solis Mammography, Texas, HB 1036, insurance coverage, 3-D mammography, tomosynthesis

March 9, 2017 — Solis Mammography, an independent provider of breast imaging services, believes that an educated patient makes the best decisions about their health. For this reason, Solis is urging support for Texas House Bill 1036 (HB1036), which if passed, would require all commercial insurance providers in Texas to cover digital breast tomosynthesis, also known as 3-D mammography, for breast cancer screening and diagnosis. House Bill 1036 was introduced on Jan. 1 by Texas Rep. Senfronia Thompson (D-Houston).

In November 2014, the American College of Radiology released this position statement on 3-D mammography: “To be clear; tomosynthesis (3-D) is no longer investigational. It has been shown to improve key screening parameters compared to (2-D) digital mammography. The college applauds the decision by the Centers for Medicare and Medicaid Services (CMS) to facilitate access to these exams by covering beneficiaries for tomosynthesis and urges private payers to do the same.”

In 2016, Blue Cross Blue Shield began its 3-D mammography coverage in Texas, and Cigna announced on Aug. 23, 2016, that they would begin providing coverage, becoming the first national private insurer to cover 3-D mammograms. United Healthcare recently announced a similar decision, adding 3-D mammography to its list of covered services for screening and diagnostic mammography effective Apr. 1.

The movement has shifted to other state legislatures who have already passed similar legislation to HB1036.  These states include Connecticut, Pennsylvania, Illinois and most recently New York. 

Research has proven the effectiveness of 3-D mammography, demonstrating increases in early detection of breast cancer by 54 percent and decreases in recall rates by 37 percent, as published in the American Journal of Roentgenology. Early detection contributes to long-term survival and also to quality of life, as masses found earlier will likely result in less aggressive treatment.

“In 2010, Solis Mammography’s chief medical officer, Dr. Steven Rose, presented the very first patient in the country to be diagnosed with 3-D alone to a [U.S.] Food and Drug Administration panel,” said James Polfreman, CEO of Solis Mammography. “In 2011, the FDA approved 3-D mammography, and in 2015, Medicare announced its decision to cover 3-D. It’s been another full two years since Medicare’s decision and we are still seeing too many women who have health insurance, but can’t get the best screening technology available because of a lack of coverage. This is simply not acceptable and women deserve better.”

For women whose insurance does not cover the cost of 3-D, out-of-pocket expenses can range from $50 to $150 for the added benefits and specificity of 3-D mammography.  These benefits include:

  • It provides around 60 layers of images, allowing radiologists to see cancers as early as stage zero;
  • It is better able to see behind dense breast tissue, which is important for breast cancer detection as not all breast cancers cause a lump in the breast that can be felt; and
  • It enhances the accuracy of breast cancer screenings by increasing specificity of early detection, reducing unnecessary callbacks (aka false positives) and reducing the need for unnecessary biopsies and other follow-up testing.

For more information: www.solismammo.com

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