Health insurer Highmark will provide 100% coverage for all diagnostic breast imaging
Highmark Inc. will provide 100% coverage for MRIs and other diagnostic breast imaging services, the insurer announced recently.
Effective Jan. 1, the payer said all such scans will be paid for without any co-pays or deductibles. The new policy applies to all Highmark health plans across Pennsylvania, New York, West Virginia and Delaware, “removing financial barriers for essential breast cancer diagnostics.”
Highmark hopes the move will help encourage more health plan members to undergo any necessary follow-up imaging when recommended by physicians. Its updates apply to all Highmark policies including commercial and group plans, Medicare and Medicaid members, and those with individual Affordable Care Act plans.
“Early detection is paramount in the fight against breast cancer. When breast cancer is found early, before it has spread, the five-year survival rate is significantly higher,” Timothy Law, DO, MBA, chief medical officer at Highmark Inc., which is based in Pittsburgh, said in a statement Jan. 7. “By completely covering diagnostic breast studies and MRIs, we are removing a major financial hurdle that can often delay or prevent individuals from getting the crucial imaging they need.”
Highmark is an independent licensee of the Blue Cross Blue Shield Association, together with its affiliates comprising the fifth largest BCBS-affiliated organization in the country. It has about 7 million members across the four previously mentioned states. Highmark also is the parent company of the Allegheny Health Network, an integrated delivery system with 14 hospitals serving the greater western Pennsylvania region.
AHN offers “extensive” access to breast imaging, Highmark said, including weekly walk-in mammograms available year-round across eight convenient locations. Highmark noted that these exams, such as diagnostic mammograms, breast ultrasounds and MRIs, are used to investigate suspicious findings following a screening exam, which was already 100% covered.
“We know that convenient access to imaging, combined with the removal of financial burdens, dramatically increases the likelihood of early diagnosis,” Matthew Miller, MD, director of breast imaging at AHN, said in the announcement. “Highmark’s decision to cover these critical diagnostic tests at 100% is a game-changer for our patients. It ensures that when a finding needs further investigation, there’s no hesitation due to cost, allowing us to identify and address potential cancers sooner, when treatment is most effective.”
Local news outlets noted that the move was spurred by Pennsylvania recently passing legislation requiring insurers to cover all breast imaging exams. Last year, about two-thirds of Highmark members who got advanced breast imaging had to shoulder some of the costs, with typical out-of-pocket payments ranging from $35 to $380, Trib Live reported.
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.