# Access to Breast Cancer Diagnosis Act of 2021

This bill makes sure that health insurance companies treat diagnostic breast cancer exams the same way they treat screening exams when it comes to what you pay out of your pocket. Right now, some insurance plans charge you less for routine screening mammograms but make you pay more when you need a diagnostic exam—one that happens because a doctor found something suspicious or you have symptoms that need investigation. This bill says that can't happen anymore.

Here's what this means in practical terms: If your insurance covers a screening mammogram with no copay or a low deductible, they have to offer the same deal for a diagnostic mammogram. The same goes for other breast imaging tests like ultrasounds or MRI scans. Insurance companies can't suddenly charge you a $500 copay for a diagnostic exam when they charged you nothing for screening. They also can't limit how many diagnostic exams you can get if they don't limit screening exams the same way. The goal is to remove financial barriers that might prevent people from getting the follow-up testing they need when something concerning shows up.

The bill does include some important guardrails. Insurance companies can still require you to get approval before scheduling imaging tests, and they can use standard medical review processes to make sure tests are medically necessary. They also can't get around this rule by raising the costs of screening exams instead—that's specifically prohibited. The law applies to most health insurance plans starting in 2022, though states can create even stronger protections if they want to.

Access to Breast Cancer Diagnosis Act of 2021

Dingell, Debbie

Access to Breast Cancer Diagnosis Act of 2021 This bill prohibits private health insurance plans from imposing higher cost-sharing requirements on breast cancer diagnostic examinations than initial breast cancer screening examinations. Diagnostic examinations are generally required after an initial screening detects an abnormality and typically require additional mammogram images (e.g., x-rays).