Insurers say they won't alter mammogram coverage despite new guidelines

Nov 19 2009

Insurance companies say mammogram coverage is unlikely to change despite the debate over the effectiveness of breast cancer screenings for women in their forties.

The Washington Post: "A top federal health official said Wednesday that the controversial new guidelines for breast cancer screening do not represent government policy, as the Obama administration sought to keep the debate over mammograms from undermining the prospects for health-care reform. "Health and Human Services Secretary Kathleen Sebelius, in a written statement, said the new guidelines had 'caused a great deal of confusion and worry among women and their families across this country,' and she stressed that they were issued by 'an outside independent panel of doctors and scientists who . . . do not set federal policy and . . . don't determine what services are covered by the federal government" (Stein and Eggen, 11/19).

USA Today: "... insurance plans have not proposed changing their coverage, says Susan Pisano, a spokeswoman for America's Health Insurance Plans, which represents 1,300 companies covering 200 million Americans. Some of the companies that told USA TODAY that they will continue paying for mammograms for women in their 40s include Kaiser Permanente, Aetna, Cigna, Geisinger Health Plan, Group Health Cooperative and WellPoint, which operates Blue Cross/Blue Shield plans in 14 states. Together, these plans cover more than 73 million people" (Szabo, 11/19).

Meanwhile, "[a] group of female House Republicans used the upset over new guidelines on breast cancer screening issued by an advisory panel earlier this week to highlight what they view as the dangers of government-administered health care and the Democrats' bill to revamp the system," The New York Times reports. "It's 'an example of how government-run decisions could be made,' said Representative Cathy McMorris Rogers of Washington State, who gathered other female members of her caucus to condemn the findings on Capitol Hill Wednesday" (Lorber, 11/18).

CBS News: "Rep. Candice Miller (R-Mich.) called the recommendations 'a huge step backward' that puts the nation on a 'slippery slope' to discouraging screening for other diseases based on cost rather than medical need" (Condon, 11/18).

In a second story, The New York Times reports that clinics have long been struggling. "The business of providing mammograms has been in steady decline in recent years as many clinics have opted out of the screening business because of low insurance reimbursements. Medicare typically pays about $94 for a mammogram, and private insurers may pay an additional 20 percent or more. But the most advanced imaging equipment costs several hundred thousand dollars, and there is concern over malpractice lawsuits if radiologists read a mammogram but miss a cancer diagnosis. As a result, the number of sites accredited to conduct mammography screening in the United States has dropped more than 12 percent since 2000, from 9,933 to 8,713, according to the American College of Radiology" (Singer and Abelson, 11/18).