The New York State Department of Financial Services (DFS) on July 8 told health insurers that they must provide coverage with no cost-sharing for breast-cancer screenings, breast-cancer risk assessments, genetic testing, and medications to reduce the risk of breast cancer. DFS’s action “builds” on the series of breast-cancer initiatives outlined in Gov. Cuomo’s 2016 State […]
The New York State Department of Financial Services (DFS) on July 8 told health insurers that they must provide coverage with no cost-sharing for breast-cancer screenings, breast-cancer risk assessments, genetic testing, and medications to reduce the risk of breast cancer.
DFS’s action “builds” on the series of breast-cancer initiatives outlined in Gov. Cuomo’s 2016 State of the State address, the agency said in a news release.
Cuomo on June 27 signed legislation to increase access to breast-cancer screenings.
“The cost of important [preventive] measures, such as mastectomies and mammograms, should not be a barrier in the fight to save the lives of women and families across New York State. DFS will ensure that health insurers meet their legal obligations to cover breast-cancer screening and treatment and eliminate any obstacles women and their families may face in the fight against breast cancer, Financial Services Superintendent Maria Vullo said in the DFS release.
Requirements
The state now requires health insurers to eliminate annual deductibles, co-payments, and co-insurance payments for all mammograms.
The mammograms include those provided to women more frequently than those recommended under current federal screening guidelines such as annual mammograms for women in their 40s.
It also eliminates cost-sharing for diagnostic imaging for breast cancer, including diagnostic mammograms, breast ultrasounds, and breast MRIs for women at high risk for breast cancer.
As a result, women in need of tests other than standard mammograms will not have to pay any additional out-of-pocket expenses for these most common diagnostic tests.
In addition, the DFS action also reminds health insurers that provide coverage for surgical or medical care for mastectomies of their obligations to provide coverage for all stages of breast reconstruction.
That includes coverage of the breast on which the mastectomy has been performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and physical complications of all stages of the mastectomy.
In addition, insurers are required to provide coverage, with no cost-sharing, so primary-care providers can screen women who have family members with breast, ovarian, tubal, or peritoneal cancer using one of several screening tools.
The tools are designed to identify a family history that may be associated with an increased risk for potentially harmful mutations in breast-cancer susceptibility genes.
Insurers are also required to provide coverage for women who have positive screening results for genetic counseling and, if indicated after counseling, BRCA testing.
The BRCA gene test is a blood test that uses DNA analysis to identify harmful changes (mutations) in either one of the two breast cancer susceptibility genes — BRCA1 and BRCA2, according to the website of the Rochester, Minnesota–based Mayo Clinic.
Contact Reinhardt at ereinhardt@cnybj.com
