New Policy Requires PA Insurers to Cover 3D Mammograms at No Extra Cost to Patients

Pennsylvania insurers are now required to cover all screening mammograms, including 3D, at no out-of-pocket cost to consumers, according to a new policy announced by Gov. Wolf on Oct. 5.

“The Pennsylvania Radiological Society Breast Imaging Committee supports Gov. Wolf’s and the Insurance Commissioner’s efforts to reduce barriers to patient use of 3D mammography,” said Marcela Böhm-Vélez, MD, FACR, chairperson of the Committee. “It is hoped that reimbursement will align with the costs of providing this important service.”

3D mammograms, a service also known as “tomosynthesis,” are becoming more common as many health care facilities in Pennsylvania are replacing 2D mammography with 3D technology. The Pennsylvania Insurance Department has heard from many consumers that when given the choice of a 2D or 3D mammogram, the 3D option comes with an additional charge – typically between $50 and $60 – whereas the 2D mammogram would be free. Other consumers have reported being given a 3D mammogram without any discussion of their alternatives and receiving a surprise bill for the additional fee.

Though 3D mammography was approved in the U.S. in 2011, some insurers still consider it to be experimental and don’t automatically cover it. Last year, the American College of Radiology declared it is no longer investigational, and Medicare began covering 2D and 3D mammographies earlier this year.

October is Breast Cancer Awareness Month. Each year, approximately 12,000 Pennsylvanian women will be diagnosed with breast cancer. This increased mammography coverage is good news in the fight against this disease that takes the lives of about 2,200 Pennsylvanian women each year.

“This modern technology is offering new opportunities for physicians to diagnose breast cancer in women and provide life-saving treatment earlier than ever,” said Gov. Wolf. “Questions have arisen as to whether 3D mammograms should be covered by insurance in the same manner that traditional mammograms are. Today, I am announcing that my administration’s answer to this question is an absolute yes.”

“Three-dimensional mammograms are another way to provide vital preventive healthcare to women,” First Lady Frances Wolf, who is the honorary chair of the PA Breast Cancer Coalition. “Women must be able to receive services like these at no cost.”