Public Comments for: HB230 - Health insurance; cost sharing for breast examinations.
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AdvaMed and the AdvaMed Medical Imaging Division are writing in support of HB 230, a bill increasing access to medically necessary diagnostic and supplemental breast imaging by eliminating the burden of patient cost-sharing.
Good morning, My name is Genise Smith-Watkins, and I am the State Policy & Advocacy Manager for Susan G. Komen. I am reaching out in support of HB 230, which will eliminate cost-sharing for medically necessary diagnostic and supplemental breast imaging. For clarity on the scope of the bill, we have included the definitions of diagnostic and supplemental breast examinations according to the National Comprehensive Cancer Network (NCCN) guidelines. Widespread access to preventive screening mammography is available to millions of women as a result of the Affordable Care Act (ACA). Unfortunately, most individuals at a higher risk of breast cancer or those requiring follow-up imaging due to an abnormal mammogram result face hundreds to thousands of dollars in patient cost sharing for this required imaging – all before they are even potentially diagnosed with breast cancer. Early detection of breast cancer is not possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. A Komen-commissioned study found the out-of-pocket costs for patients to be high, with much variation for diagnostic breast imaging. For example, the average patient cost for a mammogram is $234, and for a breast MRI, $1,021. The study also found that the inconsistency in cost and coverage is a recognized concern among patients, and health care providers. This leads to additional stress and confusion for patients who are already dealing with the daunting possibility of a breast cancer diagnosis. As committed partners in the fight against breast cancer, we know how deeply important it is for all cancer patients to have fair and equitable access to breast imaging that may save their lives. As such, we support HB 230 and urge you to pass this critical legislation, which eliminates burdensome out-of-pocket costs for patients. Thank you for your consideration. Sincerely, Genise Smith-Watkins
January 23, 2024 Good afternoon, The undersigned patient and provider organizations, which advocate on behalf of the Virginia breast cancer community, encourage your support of House Bill 230. If passed, this legislation would increase access to medically necessary diagnostic and supplemental breast imaging by eliminating burdensome patient cost sharing. Studies show that individuals facing high out-of-pocket costs associated with diagnostic and supplemental imaging are less likely to complete their recommended follow-up imaging. This can mean the person will delay care until the cancer has spread to other parts of the body making it much deadlier and more costly to treat. While access to preventive screening mammography is available as a result of the Affordable Care Act (ACA), unfortunately, individuals at a higher risk of breast cancer and those requiring follow-up imaging due to an abnormal mammogram result face hundreds to thousands of dollars in out-of-pocket costs. An estimated 12% of individuals require additional follow-up imaging after an abnormal mammogram. Early detection of breast cancer is not possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for medically necessary diagnostic and supplemental imaging would improve access and utilization of the services, allowing more timely diagnosis of breast cancer. This change could also lead to improved health outcomes and reduced costs to the health care system. Sponsored by Delegate Shelly Simonds, Delegate Delores McQuinn, Delegate Jeion Ward, Delegate Kannan Srinivasan, and Senator Barbara Favola, House Bill 230 is scheduled to be heard in the VA House Labor and Commerce Subcommittee #1 on January 23, 2024. As committed partners in the fight against breast cancer, we know how deeply important it is for people to have fair and equitable access to breast imaging that may save their lives. We respectfully urge your support of House Bill 230 and encourage its passage through its first committee stop (VA House Labor and Commerce Subcommittee #1). Thank you for your leadership and continued commitment to Virginia. If you have any questions, please reach out to Genise Smith-Watkins, Susan G. Komen’s State Policy & Advocacy Manager, at gsmithwatkins@komen.org or (980) 349-9983. Sincerely, American Cancer Society Cancer Action Network American Congress of Obstetricians and Gynecologists Rayus Radiology Richmond Academy of Medicine Susan G. Komen Virginia Breast Cancer Foundation Virginia Radiological Society
The undersigned patient and provider organizations, which advocate on behalf of the Virginia breast cancer community, encourage your support of House Bill 230. If passed, this legislation would increase access to medically necessary diagnostic and supplemental breast imaging by eliminating burdensome patient cost sharing.
The VA NAACP support HB 230,692,604,906
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!
HB385: there’s an importance and safety to having two man crews.. safety for the company and the public.
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!
I support this bill and as a healthcare professional I strongly see the need for this to be implemented!
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!
“Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
I fully support the efforts put forth regarding Delegate Simmond's proposal.
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill
This bill would definitely help
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out of pocket cost for diagnostic and supplemental imaging can improve access and lead to more patients receiving an early diagnosis. Please support the bill!
Good morning, Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!
“Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
Please continue to allow any and all coverage preventive breast cancer care, treatment, and testing.
Early diagnosis is important!!! “Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
I’m in support of this bill to better help women with breast examinations.
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!” Thank you
“Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
“Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
Being from a family in which breast cancer seems to have a permanent home, I truly understand why early detection of it is extremely important, and insurance coverage for any and all follow-ups is detrimental to saving lives. Therefore, for some women, "early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!"
"Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
“Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
I am writing as a concerned citizen to express my support for Delegate Simonds' bill, HB230. This bill would protect patients from expensive out-of-pocket costs for follow-up diagnostic mammograms, ultrasounds, or MRIs. Early detection and treatment of breast cancer is essential to ensuring better health outcomes. Eliminating expensive financial barriers to accessing diagnostic breast imaging can help save lives. Delaying either diagnosis or treatment due to financial constraints can be devasting both to the individual's mental health and potential disease progression. Unfortunately, I (now) have a family history of breast cancer and when I went in for a screening, abnormalities were found that necessitated additional screenings every six months for a two-year period, which required both a diagnostic mammogram and ultrasound. While this was necessary for my health, it proved to be quite financially onerous as I struggled to figure out how to afford the expensive copays for diagnostic mammograms (which are coded differently than screening mammograms) and ultrasounds. When you're struggling with, not only coming to terms with a potentially life-altering health diagnosis, but also managing the care needed for that health condition, figuring out how to deal with the ensuing medical bills is another unnecessary and burdensome task during a particularly difficult time.
“Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
I am considered high risk due to my twin sister, older sister recently being diagnosed with breast cancer 4 years ago. I too have have coupling cysts that grew large in my breasts and had to have them removed. I will continue to be high risk and the costs to have the proper care needed to have tests, scans and ultrasounds completed become an out of pocket cost to me even with insurance. My twin sister just so happened to pay out of pocket to get that 3D imaging done even after already having a mammogram within a few months. After the scans they found the cancer which was spreading. Had she not she would possibly not have even known and she was at Stage 2. My older sister also paid out of pocket costs after my twin was diagnosed a year later, putting off the cost. She too was diagnosed with a very aggressive breast cancer! Early detection is the key and it make it very hard to receive the assistance even with insurance because it is NOT covered. I paid $75.00 three years ago. My sisters are both cancer free at this time! Still paying off some bills for care!!! Those with no insurance would never be served due to the costs as well to save their lives! I continue to be concerned about this since my daughter also had to have three cysts removed and I now have two granddaughters!
“Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
Breast cancer is most prevalent in the black community. Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Most often cancer detection is prolonged due to the lack of awareness and limited access to medical care. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!
“Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
Chances are, you know at least one person who has been personally affected by breast cancer. Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Let's help save the lives of your loved ones and friends. Please support this bill!
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!
“Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
“Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
“Early detection of breast cancer would not be possible without the medically necessary diagnostic follow-up or additional supplemental imaging required to rule out breast cancer or confirm the need for a biopsy. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!”
The timely identification of breast cancer hinges on essential diagnostic follow-ups and supplementary imaging software. These are crucial for either ruling out breast cancer or confirming the necessity of a biopsy. By removing out-of-pocket expenses, we can enhance accessibility, enabling more patients to receive early diagnoses and ultimately save lives! Please support to this bill.
My mother had breast cancer, and I am considered “high risk.” Last month, I found a lump in my right breast, and my doctor immediately ordered a diagnostic mammogram and an ultrasound. Despite having very good health care coverage, my out of pocket expense was $485.00. There are many women who could not afford this. Imagine having to choose between preventive care or daycare costs. Eliminating out-of-pocket costs for diagnostic and supplemental imaging can improve access and lead to more patients receiving an earlier diagnosis. Please support this bill!
Good evening, My name is Genise Smith-Watkins, and I am the State Policy & Advocacy Manager for Susan G. Komen. I am reaching out in support of HB 230, which will eliminate cost-sharing for medically necessary diagnostic and supplemental breast imaging. For clarity on the scope of the bill, we have included the definitions of diagnostic and supplemental breast examinations according to the National Comprehensive Cancer Network (NCCN) guidelines. I am attaching our written comments.
See attachment, please. Zachary Brunnert
As a Breast Radiologist in Richmond for 16 years, and member of the Virginia Breast Cancer Foundation and Cancer Action Coalition of Virginia, I am writing in support of HB 230. Considered the gold standard for breast cancer screening, mammography reduces the number of deaths from breast cancer by up to 40% when performed yearly in women of average risk over age 40 through early detection of stage 0 and stage 1 cancers. Thankfully it is a mandated covered service. For the approximately 10% of women called back for additional evaluation after an abnormal screening, the out of pocket cost even after insurance is billed can be significant, and deter them from returning for potentially life changing and lifesaving care. A 2023 study showed 21% of women polled would skip additional recommended imaging if they knew they had to pay a deductible (1). In another, patients in plans with higher degrees of cost-sharing had lower utilization of diagnostic imaging, and this was more pronounced for the most expensive service studied—breast MRI, which has the highest cancer detection rate of them all (2). Underinsured women, or those who have high deductible plans, face financial barriers that can lead to a delayed diagnosis of breast cancer, resulting in advanced disease that requires more aggressive, often toxic (and more costly) treatments. Yesterday I had to tell a 40 year old mother of 6 that she has breast cancer. As devastating as it is, I was able to reassure her that it is curable, her prognosis is excellent, and this will not prohibit her from living a long, healthy life. I was able to provide this hope because I found her cancer early (stage 0), on her first-ever screening mammogram. And because she was able afford the out of pocket cost for additional imaging and an x-ray guided biopsy that provided this diagnosis. As the Medical Director of Breast Imaging at my institution, I hear of patients who cancel or “no-show” for diagnostic imaging appointments because of cost at least weekly. One recent patient was told that her co-pay for the diagnostic mammogram alone would be $1500. Any necessary ultrasound, imaging-guided biopsy, and MRI would be extra. She declined all tests even after speaking with our scheduling director, nurse, and myself. Yet in DE, MD, NM, OR, TN, and WA, states in which legislation has been passed to reduce or eliminate cost-sharing for diagnostic imaging (or if this were colorectal cancer screening, for which similar legislation was passed last year by the Biden administration), she would have been able to seamlessly continue her care. Even bundling the cost of diagnostic imaging with screening could potentially remove financial barriers while limiting the increases in overall cost, and still incentivize appropriate utilization (3). There is an overwhelming amount of scientific evidence that screening mammograms save lives. But this is only possible when the next steps are taken to confirm a diagnosis of cancer. Free screenings but cost prohibitive diagnostics leave women stranded, regardless of technological advances and medical expertise. Thank you for your time and consideration of this issue amidst the myriad of your other duties. Your support for this bill would reduce the burdens of cancer for our fellow Virginians, and help close the gap of health disparities and inequities in the Commonwealth. Sincerely, Priti A. Shah, MD pshah002@gmail.com
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