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Komen Advocating for Diagnostic Legislation in 2020

Passage of state and federal legislation that requires insurers to cover the full cost of diagnostic imaging is a top priority for Susan G. Komen in 2020.

Under current law, insurers are only required to cover the cost of annual screening mammograms without pushing costs onto patients. But if that mammogram reveals an abnormality, patients then must pay out-of-pocket for any additional medically-necessary diagnostic imaging. Those tests can involve an ultrasound, breast MRI and diagnostic mammogram to determine if a biopsy is required. Out-of-pocket cost is particularly burdensome on those who have previously been diagnosed with breast cancer, as diagnostic tests are often recommended rather than traditional screening mammography.

A recent Komen-commissioned study found the costs to patients for these tests to range from $234 for a diagnostic mammogram to $1,021 for a breast MRI. It is estimated that as many as 10 percent of patients who receive annual screening mammograms get called back for diagnostic imaging.

At the federal level, the U.S. House of Representatives has introduced legislation, the Breast Cancer Access to Diagnosis Act that would eliminate costs for women who need diagnostic tests. Komen continues to meet with members of the U.S. House to urge passage of its bill, and with the U.S. Senate to get a companion bill introduced.

At the state level, Texas, Colorado, Illinois, New York and Louisiana have all passed legislation addressing this issue. More states are expected to introduce legislation this year and Komen will be working closely with advocates in those states to get the bills passed and signed into law.

CBS This Morning recently covered the issue and the financial impact of diagnostic imaging for women who get called back for additional tests.  

If you’ve been called back for a diagnostic test and had to pay any of the costs, we want to hear your story. Please share your experience with us at: