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Insurance Companies Unmoved By Mammogram Recommendations

By
Jeff Hess
@ November 18, 2009 4:31 PM
Permalink | Comments (1)
Doctors are still arguing over new recommendations for breast cancer screening, but local insurance providers say they are sticking with the old way.

Two major local insurance companies, Aetna and blue cross blue shield, are going to continue to recommend mammograms at 40 for women.
Doctor Jonathan Gavrus with Blue Cross said this is a decision they want to leave up to doctors.
"Our coverage policy reinforces that that we don't want to get in the middle of a decision as important as this. Between the physician and the patient," Gavrus explained.
He said recommendations change often and they don't want to change their plan needlessly.
Aetna released a statement saying they are reviewing the recommendation but for now they will continue to provide coverage for regular mammograms starting at 40 for women and even younger if they are at high risk for breast cancer.


Here is the whole statement from Aetna:


Aetna is committed to helping its members stay healthy and well. Preventive screening tests can lead to the early detection of disease when it is at its most treatable. For this reason, Aetna encourages its members to take advantage of routine screening tests.

Aetna is reviewing the new recommendations for breast cancer screening issued by the U.S. Preventive Services Task Force (USPSTF) on November 16th.

For members with preventive services benefits, Aetna currently covers annual screening mammograms for women beginning at age 40 years. Aetna also covers mammograms for women younger than age 40 years who have a family history or genetic risk factors that place them at heightened risk for breast cancer.

This policy will remain in place while Aetna reviews the USPSTF's recommendations, and conducts a thorough review of the current medical literature and evidence-based guidelines on this topic.

Aetna recommends that women members discuss with their doctor which breast mammography schedule is right for their individual needs. Members' personal physicians can also advise whether they should continue monthly breast self-exams.

Aetna's Clinical Policy Bulletin on Mammography

Aetna Clinical Policy Bulletins (CPBs) state Aetna's policies on the medical necessity of medical technologies and services. All of Aetna's CPBs are available on its public website at www.aetna.com (search Individuals & Families; then All Tools & Educational Materials; then Clinical Policy Bulletins)

Aetna CPB 584 outlines its policy on mammography screening, and is available at the following link: http://www.aetna.com/cpb/medical/data/500_599/0584.html

The CPB states that annual mammography screening is considered a medically necessary preventive service for women aged 40 and older. Annual screening is also considered medically necessary for younger women who are judged to be at high risk by their primary care physician.
This e-mail may contain confidential or privileged information. If you think you have received this e-mail in error, please advise the sender by reply e-mail and then delete this e-mail immediately. Thank you. Aetna



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What others are saying

  • Insurance Reviews
    BRAVO to Aetna & BCBS !!!

    Their commitment to their members should be a wake-up call to all!
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