"Michelle's Law"; requires health benefit plans to cover mammogram for an individual if recommended by health care provider.
Impact
The implementation of Michelle's Law would require changes to existing health insurance policies in New Jersey by mandating coverage for mammograms based on a healthcare provider's recommendations rather than age or familial history alone. This change could significantly increase access to early detection of breast cancer for many women, potentially leading to better health outcomes. Additionally, it may result in increased healthcare costs for insurers, which could have downstream effects on insurance premiums as companies adjust to accommodate the broader coverage.
Summary
Bill S855, known as 'Michelle's Law,' aims to expand health benefit plan requirements regarding mammograms. The proposed legislation mandates that health benefit plans cover the cost of a mammogram recommended by a healthcare provider, extending coverage beyond the current requirement, which limits mandatory coverage to women aged 40 and above or those under 40 with a family history of breast cancer. This law responds to the story of Michelle DeVita, a young woman whose need for a mammogram was not covered under existing policies due to her age, ultimately linking her tragic death to the limitations of current health insurance regulations.
Contention
While the bill has strong support given its intent to improve women's health services, it may face opposition from insurance providers concerned about cost implications. Some stakeholders may argue that such mandates could make insurance less affordable. Moreover, the potential for increased utilization review requirements may invoke further debate about the balance between necessary healthcare interventions and potential overreach by the health insurance system.
Requires health care professional to order bi-lateral ultrasounds concurrently when ordering mammograms; requires insurers to cover concurrent mammograms and bi-lateral ultrasounds.
Requires health care professionals to order bi-lateral ultrasounds concurrently when ordering mammograms; requires insurers to cover concurrent mammograms and bi-lateral ultrasounds.