Katie Couric diagnosis highlights lack of RI insurance mandate for breast ultrasounds

PROVIDENCE, R.I. (WPRI) — When former CBS Evening News anchor Katie Couric disclosed her breast cancer diagnosis Wednesday, she also highlighted a little-known fact: most states, including Rhode Island, don’t require insurance providers to cover the cost of breast ultrasounds, a common preventative screening.

In a personal essay, Couric said because she has dense breast tissue, she routinely gets an ultrasound in addition to her annual mammogram, which she did earlier this year. The screening ultimately resulted in her diagnosis of stage 1A breast cancer.

“Only 14 states and the District of Columbia require insurance companies to fully or partially reimburse patients for the cost of potentially lifesaving breast ultrasounds,” Couric wrote. “That means far too many women are not benefiting from a technology that will allow their breast cancer to be diagnosed early, when it’s most treatable.”

The National Cancer Institute says nearly half of women who receive mammograms are found to have dense breasts, and the CDC says those with dense breasts have a higher risk of getting breast cancer. Doctors often recommend ultrasounds or breast MRIs to get a different visual than the mammogram provides.

Several states including Connecticut, New York and Texas mandate that insurance covers those additional screenings for women with dense breasts.

Rhode Island is one of the states that does not require insurance to cover the cost of preventative breast ultrasounds. That means many women have to pay out of pocket for breast screenings depending on their insurance coverage. (Mammograms are required to be covered under the Affordable Care Act.)

A law passed in 2014 does mandate that Rhode Island patients be notified if they have dense breasts.

For several years in a row, state Rep. Kathleen Fogarty has introduced legislation that would require insurance to cover ultrasounds, breast MRIs and 3D mammograms — called DBTs — for those who are found to have dense breasts.

Dense breasts can “make it more difficult to see any type of breast cancer on a mammogram,” Fogarty said while testifying in favor of the bill last year. “We should provide them at no extra cost … the opportunity to receive a screening.”

The most recent version of the legislation was held for further study in the Health and Human Services committee earlier this year. It was not brought to a vote, and there was no similar bill considered in the Senate.

Asked why the bill did not get a vote, Larry Berman, a spokesperson for House Speaker Joe Shekarchi, cited testimony about financial implications, including from business groups and insurer Blue Cross & Blue Shield Rhode Island. (Blue Cross said they already cover DBTs.)

“While the merits of this issue are extremely important, the House Health and Human Services Committee held this bill for further study.” Berman said. “The committee will continue to carefully review this bill should it be introduced again next year.”

In its testimony against the bill, the Rhode Island Business Coalition argued health insurance policy shouldn’t be approved in a “piecemeal fashion,” and said mandated health insurance benefits have increased the cost of group health insurance premiums.

Patrick Tigue, Rhode Island’s health insurance commissioner, separately testified last year that imposing a new benefits mandate could trigger a federal requirement in the Affordable Care Act that states pay insurance companies for new mandates.

It’s not entirely clear whether that requirement would be enforced, or how much it would cost. Asked to elaborate Wednesday, Tigue said he has a responsibility to inform the legislature of the potential costs, but also said covering the breast screenings would provide “critical access.”

“Federal regulation is clear on this obligation of states, but what would ultimately occur in any individual instance is the decision of Centers for Medicare and Medicaid Services,” Tigue said in an email. “That said, I absolutely agree that robust coverage of preventive screenings such as those described in the bill will promote needed access, regardless of whether federal benefit defrayal requirements are triggered.”

Fogarty could not be immediately reached Wednesday, but she previously pushed back at the cost concerns, arguing that delayed breast cancer treatment could be more expensive.

“I think it’s foolish to worry about doing an extra test, when you’re going for treatment down the road,” Fogarty said last year. “That’s always been my contention, I know they always push back on that. … An ounce of prevention is worth a pound of cure. You’re going to pay the money later down the road if we miss something.”

Steph Machado (smachado@wpri.com) is a Target 12 investigative reporter covering Providence, politics and more for 12 News. Connect with her on Twitter and on Facebook.

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