Mammography in Connecticut
Starting Jan 1 2012 a CT law kicked in requiring insurance companies to cover in the same way mammograms or the ultrasound type of mammograms used for women with denser tissues where regular mammograms don’t show up clearly. About 15% of women require this type of mammogram.
For anyone who has an Aetna plan in CT:
Client X (who has a grandfathered Aetna individual plan) got this second type of ultrasound/mammogram and was charged $180 after Aetna’s re-pricing. I advised her to call because there is this new law and it should be free. The Aetna rep told her that only mammograms were covered, not the procedure she had. When she mentioned that there was a new law the answer was unchanged. Most people would give up at that point.
Then the rep said …wait let me double check. She came back on the line and said it was covered 100% w/ no charge and the claim would be reprocessed.
Connecticut General Statutes 38a-530 – Mandatory coverage for mammography and breast ultrasound
a) Each group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered, issued for delivery, renewed, amended or continued in this state on or after October 1, 2001, shall provide benefits for mammographic examinations to any woman covered under the policy which are at least equal to the following minimum requirements: (1) A baseline mammogram for any woman who is thirty-five to thirty-nine years of age, inclusive; and (2) a mammogram every year for any woman who is forty years of age or older. Such policy shall provide additional benefits for comprehensive ultrasound screening of an entire breast or breasts if a mammogram demonstrates heterogeneous or dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology or if a woman is believed to be at increased risk for breast cancer due to family history or prior personal history of breast cancer, positive genetic testing or other indications as determined by a woman’s physician or advanced practice registered nurse.
(b) Benefits under this section shall be subject to any policy provisions that apply to other services covered by such policy.