Arizona passes legislation requiring insurers to cover follow-up breast imaging
Arizona has become the latest state to require that health insurers cover supplemental breast imaging such as MRIs and ultrasounds.
Democratic Gov. Katie Hobbs on June 19 signed SB 1165 into law followings its passage in the Senate. Introduced by Republican Sen. Hildy Angius in January, the bill forbids hospitals, health insurers and other providers from imposing cost-sharing requirements for breast cancer screening or any follow-up testing.
Patient advocacy group Susan G. Komen said the legislation’s passage comes after years of lobbying lawmakers to address this issue. It believes the bill will allow scores of women to receive needed breast care “without fearing bankruptcy.”
“Thousands of Arizonians require diagnostic and supplemental breast imaging every year, yet due to the high out of pocket costs, many forgo these critical services. Not anymore,” Molly Guthrie, VP of policy and advocacy at Komen, said in a statement June 22. “This lifesaving legislation ensures they can receive the breast imaging they require, likely leading to earlier diagnosis and better health outcomes.”
While the Affordable Care Act required insurers to cover regular screening mammograms, it failed to address necessary follow-up services. Oftentimes, women with dense breast tissue, a genetic disposition to the disease, or inconclusive initial results require additional imaging. This can result in patient out-of-pocket costs at anywhere from $234 for a breast ultrasound to over $1,000 for an MRI, according to a Komen-commissioned analysis. These added costs lead to 1 in 5 women opting to forgo additional testing if they don’t have the funds, another study found.
Senate Bill 1165 is slated to take effect on Jan. 1 of next year. It defines “additional screening services” as including a diagnostic breast exam and medically necessary follow-ups such as diagnostic mammograms, MRIs, ultrasounds, and molecular imaging. Both payers and providers are forbidden from charging patients deductibles, co-insurance, co-payments or similar fees for testing.
Komen estimates that over 30 states have now passed legislation requiring supplemental breast imaging coverage, including Alabama and Wisconsin earlier this year. The patient advocacy group and radiology associations also have pushed for a national fix to this issue in Washington.
“Thirty states, ranging across the political spectrum, have acknowledged the importance of removing financial barriers to lifesaving diagnostic testing for breast cancer at a critical time in a woman’s life,” Arizona Sen. Angius said in a statement earlier this year.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.