New law requires coverage of breast exam through insurance

EDINBURG — Texas women can now obtain a diagnostic mammogram at no cost through their insurance provider thanks to a new law that was enacted earlier this year.

The diagnostic mammogram is the most accurate exam when it comes to detecting breast cancer, and previously women had dish out between $300 to $1,000 to pay for it.

“Women shouldn’t have to look at their bank account to determine whether they need a diagnostic mammogram,” state Rep. Terry Canales said Wednesday at Doctors Hospital at Renaissance, where a news conference was held to announce the law.

State Sen. Carol Alvarado, D-Houston, traveled to the Rio Grande Valley to make the historic announcement. Alvarado and State Rep. Diego Bernal worked together during the 86th legislative session to pass HB 170.

While traditional screening exams are typically covered at no cost, a diagnostic mammogram, which doctors typically order after an abnormality is found, was not. HB 170 changed that by requiring insurance plans to fully cover it.

“If you’ve ever gone to get a mammogram and there’s an abnormal reading and you have to get that diagnostic mammogram, you’re insurance won’t cover it,” Alvarado said. “If a woman cannot afford that, she may have to save up money for a couple of months. Meanwhile, if she has breast cancer, it’s progressing.”

Each year, more than 40 million screening mammograms are performed throughout the United States, according to Dr. Carlos Garcia Cantu, chairman of the breast care center at DHR. Of those, about 10% of patients will be called back and a majority of them will require a diagnostic mammogram.

“Out of those, 4 to 5 percent will have breast cancer,” he said.

Dr. Ricardo Martinez, chairman of the cancer committee at DHR, called it a benefit to physicians and patients, alike.

“This will definitely help us to make an earlier diagnosis if a cancer is there, and it will help to screen people earlier,” he said. “Unfortunately, the cost of the mammogram can be prohibitive to patients, especially in this area. We deal with uninsured patients all the time.”

But even those with insurance often faced high deductibles, depending on their plans, he added.

“So we may be able to save lives,” Alvarado said. “And even if we just save one life, everything that we’ve done in support of this bill, and not just me … (is worth it).”

Texas is only the fourth state in the United States to pass such a law, she said, praising the local lawmakers who helped carry the bill in the state House and Senate, including Canales, Sen. Juan “Chuy” Hinojosa, and Rep. Bobby Guerra.

“We’re so happy and grateful that the bill finally made it through both houses and became law,” Guerra said. “I remember when this bill came through (the insurance committee) and it didn’t quite make it through. I was perplexed — absolutely perplexed…”

“But they finally got it, and they got it through your help senator.”

Canales called it “common-sense legislation” and “forward thinking” that will save Texas hundreds of millions of dollars.

“The fact of the matter is that Texas is not always at the forefront of women’s health.

And when Texas stands out, head and shoulders above what many other states are doing, the rest of the country should take note,” he said. “We hear so much about breast cancer awareness. This is action. This isn’t awareness.”