Insurance policies have inconsistent coverage for cancer screening

November 2, 2016

FOR IMMEDIATE RELEASE

Contact: Lisa Berry
703-519-2107
Lisa.Berry@preventcancer.org

New e-book and tool show inconsistent insurance policies for cancer screening tests; not all patients get the coverage they need and deserve
Prevent Cancer Foundation says inconsistencies are a result of multiple cancer screening guidelines

Alexandria, VA (November 1, 2016) – Cancer screening is one of the country’s greatest public health achievements, yet insurance coverage of screening tests varies by health care plan, according to a new review by the Prevent Cancer Foundation. Along with the review, the Foundation released a new digital tool that allows anyone to easily compare their plan’s coverage of screening tests for breast, cervical, colorectal, lung and prostate cancers with other health insurance plans available in their state.

The Foundation published its findings in “Cancer Screening: A Review of Guidelines and Insurance Coverage,” available in an e-book published by Mary Ann Liebert, Inc. publishers. The e-book summarizes current screening options and provides an overview of screening guidelines issued by the American Cancer Society, the National Comprehensive Cancer Network (NCCN) and the U.S. Preventive Services Task Force (USPSTF). It also compares screening coverage by the nation’s 30 largest health insurers.

Some of the trends identified in the comparison of insurance coverage, at the time of data collection in September 2016, are as follows:

  • While all 30 plans cover 2D mammography, only 13 plans cover 3D mammography for breast cancer screening.
  • Virtually every plan covers low-dose CT for lung cancer screening; Pap tests alone or in combination with HPV tests for cervical cancer screening; and fecal occult blood test (FOBT), stool-based DNA testing, colonoscopy and flexible sigmoidoscopy for colorectal cancer screening.
  • All but two plans cover prostate-specific antigen (PSA) tests for prostate cancer screening, even though the USPSTF does not recommend this test for men at average risk.

“People need to be aware that their health plans may not cover every screening test available for all the types of cancers that we can detect early, even if those tests are recommended by their physicians,” said Carolyn R. Aldigé, President and Founder of the Prevent Cancer Foundation. “When patients lack access to cancer screening tests, their lives are at risk and we collectively fail to deliver on one of the country’s greatest public health achievements.”

The cancer screening coverage tool, designed to help consumers understand their insurance coverage for cancer screenings, was built using data generated by Policy Reporter. Insurance companies are required to cover screenings recommended by the USPSTF, but may choose to cover additional screening tests as well.

A closer look at the data for breast cancer shows an alarming number of plans without a policy:

Screening Test

# Plans Covering

# Plans Not Covering

# Plans Without Policy

Mammography (2D)

132

0

274

Breast Tomosynthesis (3D)

47

45

313

 

This situation is not unique to breast cancer screening, and underscores an inconsistency that extends to screening guidelines issued by the American Cancer Society, NCCN and the USPSTF. The coverage tool features a pocket guide on these organizations’ recommendations, which patients should discuss with their health care providers.

“While your insurance company may pay for a test even if it does not have a specific policy, this information suggests that patients should talk to their insurance companies about coverage and demand a change if these critical screening tests are not being covered,” Aldigé said.

“Effective cancer screening can lead to early detection of these potentially deadly diseases—but the variation between guidelines allows insurance companies to adopt cancer screening policies that  may adversely affect patients’ access to preventive services,” said Bernard Levin, MD, Co-chair of the Prevent Cancer Foundation Scientific Review Panel.

In addition to the paper on cancer screening guidelines and insurance coverage, the e-book contains a selection of previously-published studies which examine the impact of cancer screening on patient outcomes.

The coverage tool and the e-book are available at preventcancer.org/insurancecoverage.

About The Prevent Cancer Foundation

The Prevent Cancer Foundation is one of the nation’s leading voluntary health organizations and the only U.S. nonprofit focused solely on cancer prevention and early detection. Founded in 1985, it has catapulted cancer prevention to prominence and fulfills its mission through research, education, outreach and advocacy across the country.

For more information, please visit www.preventcancer.org.

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