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| December 3, 2015 |
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| Coverage for Screening Mammography On October 5, 2015, Pennsylvania Governor Tom Wolf, announced clarification to the existing state law mandating coverage for screening mammography as a Preventive benefit with no cost-sharing for members. In his announcement, Governor Wolf stated that Digital Breast Tomosynthesis (DBT), also known as 3D mammography, should be covered in the same manner as traditional two-dimensional screening mammography. The Pennsylvania mammography law applies to commercial health insurance plans sold in Pennsylvania, including those made available under the Affordable Care Act. In response to this clarification, Independence will now cover 3D mammography screenings for members to whom the mandate applies, for dates of service on and after October 5, 2015. Claims system updates will be completed this week so members who have received a claims denial for a 3D mammogram performed on or after October 5th but processed before claims system updates were complete will have received an explanation of benefits with instructions for appealing the denial. Our commitment to preventive health services for women At Independence, we have a long-standing commitment to providing preventive health services for women. Our commitment and coverage of mammograms has not changed in light of the American Cancer Society’s (ACS) recent release of modified screening mammography guidelines. The ACS’s guidelines recommend that women with an average risk of breast cancer undergo regular screening mammography starting at age 45. While Independence recognizes this guidance, we generally do not place age restrictions for mammography screenings. We encourage members to consult with their physicians to determine a screening schedule for breast cancer based on their personal circumstances. If you have questions, please contact your Independence account executive.
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