Md. Mammogram Coverage to Remain Unchanged Despite New Recommendations


WASHINGTON (Nov. 27, 2009) - Marylanders will not see any immediate changes to their health insurance coverage in light of the new breast cancer screening recommendations, health officials and insurance companies said.

Women should have routine mammography every two years starting at age 50, instead of having it yearly at 40, according to the new guidelines from the United States Preventive Services Task Force. In a report published last week in the medical journal "Annals of Internal Medicine," the task force also recommended against teaching women self-breast examination, citing anxiety and unnecessary tests and treatments caused by false alarms.

The task force, a division of the Department of Health and Human Services, is an independent panel of experts in primary care and prevention.

The recommendations, which came amid the health care reform debate in Congress, have led to speculation that the government and the insurance companies might stop covering the preventive service.

Maryland residents insured by the state will not see any immediate modifications in their coverage because it involves "the most complicated process" and "nothing is likely to change rapidly," according to Rex Cowdry, executive director of the Maryland Health Care Commission.

However, the guidelines may affect future policies under the Maryland Health Insurance Plan, which covers high-risk individuals unable to get health insurance from other sources. The plan usually follows the panel's recommendations and the changes, if any, would be effective July 1, according to Cowdry.

"If we are going to spend 16 percent of the GDP wisely, we will have to follow where the evidence leads," Cowdry said, referring to the nation's health care spending.

Any discussion on the coverage issue will be "heated," Cowdry said.

The guidelines will also not affect Medicare coverage, as the changes involve "a formal rulemaking process," according to the Centers for Medicare and Medicaid Services.

"There has been debate in this country for years about the age at which routine screening mammograms should begin, and how often they should be given. The Task Force has presented some new evidence for consideration, but our policies remain unchanged," said Health and Human Services Secretary Kathleen Sebelius in a statement last week. "Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action."

Private insurance providers in Maryland, including Kaiser Permanente and Aetna, said that no changes, based on the new recommendations, would be made "at this time."

"A decision about mammography requires a detailed discussion between the patient and her physician and it should consider the medical evidence, patient preferences and unique clinical issues for each patient," said Debora Spano, UnitedHealthcare regional spokeswoman. "Mammography coverage at UnitedHealthcare has always been based on this philosophy."

CareFirst follows the American Cancer Society guidelines that continue to recommend routine mammograms starting at age 40, said Dr. Daniel Winn, vice president and senior medical director.

The new recommendations have also led to confusion and anxiety among women.

"The best thing to do is find the cancer early," said 60-year-old Bethesda resident Holly Joseph."That's what we have known all along and this recommendation goes against it."

The American Cancer Society reports that more than 3,600 Maryland women are expected to be diagnosed with breast cancer in 2009.

Capital News Service contributed to this report.

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