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25 August, 2017

Get Screened. No Excuses.

Get Screened. No Excuses.

Legislation signed by Governor Cuomo last year makes breast cancer screening more accessible and affordable for women starting on January 1, 2017. However, limitations apply and we ask that you contact your insurance provider regarding coverage eligibility. Patients will be billed directly if their insurance provider denies payment. 

Annual Deductibles/Eligibility:

Women who have health insurance policies subject to New York law do not have to pay any out-of-pocket costs (for example, annual deductibles, co-payments, or coinsurance – so called “cost-sharing") for medically necessary breast cancer screening and diagnostic imaging.

Coverage & Limitations

The law removes cost-sharing for mammograms, including:

  • A single, baseline mammogram for women 35-39 years old,

  • Yearly mammograms for women 40 years of age or older, and

  • Mammograms for women at any age who are at an increased risk of breast cancer because they have a prior history of breast cancer, or they have a first degree relative (e.g., parent, sibling, child) with breast cancer.

Other breast imaging such as diagnostic mammography, 3D mammography (also known as digital breast tomosynthesis), breast ultrasound, and breast MRI may be covered at no cost if approved by your insurer.

"No Cost-Sharing" Breast Cancer Screening and Diagnostic Imaging May Not Apply if Your:

  • Health policy or contract has yet to renew for 2017

  • Provider is outside of your health plan's network

  • Health plan is out-of-state (not subject to New York law)

  • Health plan is self-insured or ERISA (governed only by federal law)

  • Coverage is through Medicare, Medicaid, or Medicare Advantage

FREQUENTLY ASKED QUESTIONS

Below are a few of the FAQ’s regarding this new law. For more information about the breast cancer screening law, please visit the New York Department of Health website.

What does No Cost-Sharing Mean?

No cost-sharing means that women who have health insurance policies covered by this law do not have to pay any out-of-pocket costs. We ask that you contact your insurance provider regarding coverage eligibility prior to scheduling an exam.Patients will be billed directly if their insurance provider denies payment.

Does This Law Require Insurers to Cover Digital Tomosynthesis (Also Known As 3-Dimensional, Or 3-D Mammograms)?

No. As with most other tests, each insurer determines whether digital tomosynthesis (3D mammogram) is medically necessary. If the insurer determines digital tomosynthesis is medically necessary, the law requires the service to be covered at no cost to the patient when it is provided by a participating provider. If an insurer determines digital tomosynthesis (3D mammogram) is not medically necessary, the insured individual has the right to an internal and external appeal of that decision. An internal appeal is made directly to your insurer. An external appeal is made to the Department of Financial Services. For information regarding external appeals, please click here.

Does This Law Require Insurers to Cover All Breast Ultrasounds and Breast MRIs?

No. As with most other tests, each insurer determines whether a breast ultrasound or breast MRI is medically necessary. If the insurer determines a breast ultrasound or breast MRI is medically necessary, the law requires the service to be covered at no cost to the patient when it is provided by a participating provider. If an insurer determines a breast ultrasound or breast MRI is not medically necessary, the insured individual has the right to an internal and external appeal of that decision. An internal appeal is made directly to your insurer. An external appeal is made to the Department of Financial Services. For information regarding external appeals, please click here.

Please contact your insurance provider regarding coverage eligibility prior to scheduling an exam. Patients will be billed directly if their insurance provider denies payment.

 

Contact Us

Use the form below to schedule your breast screening exam. A member of our expert staff will respond quickly.

25 August, 2017 | NEWS
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