New Hampshire Issues Consumer Alert on Insurance Denials and Mammograms

June 6, 2016

The New Hampshire Insurance Department has issued a consumer alert Monday on health insurance denials and mammograms.

The department said that since Jan. 1, it has heard from 67 New Hampshire women who received notice from their health insurance companies that charges for their annual preventative mammogram were not covered.

The department noted that under the Affordable Care Act, most insurance plans must provide full coverage — at no cost to the consumer — for preventive health services, including screening mammograms. (However, a few plans that have been in place since March of 2010 are considered “grandfathered” and do not conform to the Affordable Care Act’s requirement that preventive services be provided at no cost to the consumer.)

Regulators said the recent denials involve a newer technology called a 3-D mammogram, or Digital Breast Tomosynthesis. In multiple instances, women were billed, even for a preventive screening mammogram, because insurers claimed this test has not been proven more effective than a standard mammogram.

In response, the department has reminded New Hampshire health insurers that it is their responsibility to ensure that people who see a health care provider for a routine, in-network, preventive procedure are not billed. The department’s formal guidance, issued April 1, is online at: www.nh.gov/insurance/media/bulletins/2016/documents/ins.no.16-018-ab.pdf.

The department said that if a New Hampshire resident receives a bill for a preventive mammogram screening, the bill is most likely an error. The department advises women to call their health insurers right away to ask that the charge be removed.

Consumers who experience difficulty with this process can get help from the department’s consumer services division.

“The Insurance Department’s role is to look out for New Hampshire residents and make sure they are being treated fairly, according to the law, by their insurance companies,” said New Hampshire Insurance Commissioner Roger Sevigny.

“While we will leave it to the companies and to health care providers to determine whether one form of mammography is more effective than another, we have placed the onus on insurance companies to give women in the Granite State the benefits they are due,” Sevigny said, “They must receive routine, in-network preventive mammograms at no cost.”

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