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Wolf administration: 3-D mammograms covered by insurance in Pa.

By David Singer 3 min read
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Women shouldn’t be discouraged from finding out if they have breast cancer, says the Wolf administration, which reminded Pennsylvanians and insurance companies Oct. 2 that all mammograms should be paid for by patients’ insurance.

The announcement from Frances Wolf, wife of Gov. Tom Wolf, was actually a prompt to insurance companies to stop passing the buck of paying for 3-D mammograms to patients after it was found some hospitals and insurance companies were disregarding a 1992 statute requiring “minimum coverage to include all costs associated with a mammogram every year for women 40 years of age or older and for any (prescribed mammogram) for women under the age of 40.”

“We were hearing in recent weeks that women were being offered a choice (between 2-D and 3-D technology), and some were opting out of a recommended 3-D scan because of a 50- or 60-dollar surcharge,” said Ron Ruman, press secretary for the Pennsylvania Insurance Department.

Ruman said he couldn’t provide specifics of the incidents. He said if patients receive a mammography bill, they should first try to settle it with their insurance company before going to insurance.pa.gov to file a complaint.

“This isn’t so much a policy change as it is simply acknowledging what has been state law for 23 years, and reminding patients they should not be deterred from a potentially life-saving diagnostic test,” Ruman said, explaining it’s between a doctor and patient what test they opt to have. Health professionals say a 3-D test is more exhaustive, but throws more radiation at the patient.

“A candidate for a 3-D mammogram has one of the following going on: they have dense tissue, they’ve had cancer before, or they have a family history or are otherwise at higher risk than most women,” said Dr. William Poller, director of breast imaging at Allegheny General Hospital. The 2-D technology is otherwise reliable for most patients, he said. Patients have been heeding Poller’s advice.

“I have dense breasts, and so do my three sisters,” said Patty Robich, 53, of Wexford, who had the 3-D exam in October 2014.

“I’ve had no positive screenings, but my mother had lumps removed, so there’s a family history. … Dr. Poller has told me, ‘Look, the density you have makes spotting any cancer like looking for a snowball in a drift during a blizzard,'” she said.

After the Food and Drug Administration approved the 3-D technology in February 2011, almost all regional health-care providers have since installed some form of the mammography test, except for the Washington Health System in Greene County.

“We’ve had 3-D for almost a year now. It’s in our Women’s Center (in the Outpatient Treatment Center) at Meadows Landing on Route 19. And we’re promoting it in Greene County, but we don’t have a machine in that region yet. So we have been arranging appointments at our Washington facilities,” said Washington Hospital marketing manager Stephanie Wagoner.

Representatives with the region’s two largest insurance providers, UPMC and Highmark, said their organizations would comply with the policy update and continue to invest in research on better tests.

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