Insurance Coverage Mandates and the Adoption of Digital Breast Tomosynthesis

Abstract

This cohort study assesses the association of state-level mandates requiring coverage of digital breast tomosynthesis (DBT) for breast cancer screening with DBT use, price, and out-of-pocket payments.

Toward Uniform Insurer Coverage for Functional MRI Following Severe Brain Injury

“…The catalytic role of insurer coverage on diffusion of technological innovations in medicine has been well described. For example, state health insurance mandates requiring coverage of imaging-based techniques including mammography for breast cancer screening and updates to Centers for Medicare & Medicaid Services reimbursement structures have been major drivers of medical technology adoption in breast cancer evaluation, even at times dwarfing evidence of clinical effectiveness in driving utilization 29–32. Bringing real-world clinical practice into alignment with the aspirational diagnostic standard of care emanating from professional society guidelines will thus require payers to conscientiously update reimbursement structures to routinely cover use of fMRI for the detection of consciousness in patients following severe brain injury.…”

Impact of Health Care–Associated Cost Concerns on Mammography Utilization: Cross-Sectional Survey Results From the National Health Interview Survey

“…Although the Affordable Care Act requires public and private health insurance companies to cover screening mammography with no copays or deductibles to improve access, fear of downstream costs related to a potential cancer diagnosis or patient misinterpretation of coverage parameters may result in nonengagement with routine screening [10]. In addition, there may be unexpected costs associated with use of advanced technologies during screening mammography examinations including digital breast tomosynthesis, which may deter mammography use [11].…”