Senate Bill S3510

                                BILL NUMBER:S3510

TITLE OF BILL:  An act to amend the insurance law, in relation to
health insurance coverage for follow-up ultrasound for breast cancer
screening

PURPOSE:  In 2012, New York passed legislation which mandates that
women who undergo a mammogram must be informed by their doctor if the
test indicates that they have dense breast tissue. Dense breast tissue
can make it difficult to detect breast cancer, In many cases, a
further evaluation, using digital mammography or ultrasounds, is
necessary to rule out cancer. Mandating that doctors inform women of
these options will doubtlessly save lives.

Some women, however, are discovering that follow-up visits for digital
mammograms or ultrasound procedures are not covered by their health
insurance. While notification is a good first step in improving the
screening for breast cancer, ensuring that necessary follow-up
screenings are covered by health insurance is similarly necessary.

SUMMARY OF PROVISIONS:

Section 1 of the bill amends section 3216 of the insurance law in
relation to coverage for a follow-up ultrasound, in the event that a
physician determines that a covered person has extremely dense or
heterogeneously dense breast tissue.
              

Section 2 of the bill amends section 3221 of the insurance law in
relation to coverage for a follow-up ultrasound, in the event that a
physician determines that a covered person has extremely dense or
heterogeneously dense breast tissue.

Section 3 of the bill amends section 4303 of the insurance law in
relation to coverage for a follow-up ultrasound, in the event that a
physician determines that a covered person has extremely dense or
heterogeneously dense breast tissue.

Section 4 of the bill is the effective date.

JUSTIFICATION:  The relation between dense breast tissue and cancer
risk is immense.  Women with dense breasts have been shown to have a
four- to six- fold increased risk of developing breast cancer.
Extremely dense breasts are not uncommon. In the U.S., ten-percent of
women are classified as having extremely dense breasts.

Breasts consist of a mixture of fibrous and glandular tissue and fatty
tissue. Breasts are considered dense if they have a lot of fibrous and
glandular tissue but not much fat.

On a mammogram, dense tissue appears white. Both benign and cancerous
lumps also appear white. Therefore, mammograms are less accurate for
women with dense breast tissue. Breast tissue density is classified by
radiologists using a four level density scale. This scale ranges from
almost entirely fatty, to scattered areas of fibro glandular density,
to heterogeneously dense and to extremely dense. Only ten-percent of
women have almost entirely fatty breast. Therefore, ninety-percent of
women are at risk of an inaccurate mammogram.


Studies have shown that for women with dense breast tissue, ultrasound
and magnetic resonance imaging (MRI) are more accurate tests for
detecting breast cancers than a mammogram. Ultrasound and MRI
technology can find breast cancers that cannot be seen on a mammogram.
An ambiguous mammogram will result in the recommendation of a further
evaluation using ultrasound and magnetic resonance imaging (MRI) by
one's doctor. The issue is that said further evaluation, which is
necessary to detect cancer, is often not covered by one's insurance.

In 2012, legislation was passed by New York mandating that women who
undergo a mammogram must be informed by their doctor if the test
indicates that they have dense breast tissue. This notification will
result in a follow-up evaluation. However, many women have found that
these follow up procedures are not covered by their health insurance.
Although this notification is very helpful, it is essential that the
resulting necessary follow-up procedures be covered by a woman's
health insurance. Ensuring this coverage will undeniably save lives.

BILL HISTORY:  2014: A.8210

FISCAL IMPLICATIONS:  This bill will increase the number of
individuals covered by health insurance for follow-up ultrasound and
magnetic resonance imaging (MRI) procedures to detect breast cancer.

EFFECTIVE DATE:  This act shall take effect on the sixtieth day after
it shall have become a law and shall apply to all policies and
contracts issued, renewed, modified, altered or amended on or after
such date.