Health insurance coverage requirements for mammograms, colonoscopies clarified by new bill in House

A bill is moving quickly through the Vermont House this week that clarifies a requirement that health insurers cover the total cost of mammograms, colonoscopies and additional exams associated with these cancer tests.

Rep. George Till, D-Jericho, who introduced H.136, said that a 2007 law pertaining to coverage of colonoscopies and a 2009 law regarding coverage of mammograms should already provide full coverage for these preventive services. But the existing laws aren’t always effective.

“It’s already in the statute,” Till said. “It’s just we’ve had a lot of people go in and get an unexpected bill. There’s clearly a problem, but it’s not clear how much of the problem is with insurers and how much of it is a problem with hospitals and providers.”

The bill would clarify existing statutes under Title 8. And in a state that has a breast cancer rate above the national average, the only physician in the House of Representatives said it’s very important that Vermonters are screened on schedule for breast and colon cancer.

“If people think it’s going to cost them a significant amount of money, they won’t get them,” he said. “It’s a matter of making sure people have access to the testing they ought to be having.”

Susan Gretkowski, a lobbyist for MVP Health Care, said the insurance company would not experience a change as a result of the clarification. She said the problem was with how some providers were interpreting the law. The new provision won’t affect MVP ratepayers, she said.

“Since we’re already doing this, there will be no impacts on rates,” she said. “Right now, we already cover the types of things that would be required in the bill, so if it’s a screening mammography and they need an extra film, we would cover that with no additional patient out-of-pocket.”

The House unanimously voted to move H.136 forward on Tuesday, and the bill is headed for third and final reading on the House floor this Wednesday.

Andrew Stein



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