Vermont women will not have to pay out-of-pocket for preventative mammograms

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Vermont women will not have to pay out-of-pocket for preventative mammograms

Tue, 12/12/2017 - 4:54am -- tim

Vermont Business Magazine After months of working on a solution to a breast cancer screening impediment, the American Cancer Society Cancer Action Network (ACS CAN) wants all Vermont women to know that a state law passed in 2013, which eliminated out of pocket cost sharing for screening mammograms and any “call-back” mammograms, is now fully operational.

Despite being state law for four years, some Vermont women were still being billed when they had to go back to the doctor’s office for a “call-back” or follow up mammogram.  Approximately 10 percent of women who have screening mammograms are “called back” or asked to return to their provider for additional imaging.  After a thorough analysis, in which ACS CAN worked with Vermont providers and Vermont insurance carriers, it was determined that the way call back mammograms were coded was the reason women continue to face bills for the follow-up imaging. 

After months of meetings and discussions, ACS CAN helped create a workgroup with members from the Vermont Healthcare Advocate’s Office, UVM Medical Center, Central Vermont Medical Center, Rutland Regional Medical Center, the Vermont Association of Hospital and Health Systems, Blue Cross Blue Shield of Vermont, MVP, Cigna and the Department of Financial Regulation.  The workgroup endeavored to create an updated system of coding and has begun a concentrated outreach effort to educate patients, clinicians and coders statewide.

“There will be an estimated 530 new cases of breast cancer diagnosed in Vermont this year and 70 deaths,” said Bill Sherman, ACS CAN managing director of government relations. “In 2014, only 56 percent of Vermont women 40 years of age and older had mammograms. It is crucial for Vermont women to talk to their physicians and get their mammograms as recommended because early detection not only saves money but saves lives. Now that the law is totally functional, women will not be subject to out-of-pocket cost sharing for screening or follow-up imaging and, therefore, they will not face barriers to getting these lifesaving screenings.”

“ACS CAN applauds the work done by leadership at the Department of Financial Regulation and the Healthcare Advocate’s Office, as well as our fellow advocates and Vermont insurance companies, to remedy this issue. This solution has the potential to provide all women with Vermont-based insurance access to zero-cost screening mammography,” continued Sherman.

This law also applies to certain procedures related to colonoscopies.

ACS CAN is the non-profit, non-partisan advocacy affiliate organization of the American Cancer Society, which is dedicated to eliminating cancer as a major health problem. ACS CAN works to encourage lawmakers, candidates and government officials to support laws and policies that will make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer. For more information, visit www.acscan.org.

Source: MONTPELIER, VT –December 11, 2017 – American Cancer Society Cancer Action Network