News: 2009 Press Release
For Release: November 18, 2009
Media Calls Only: 916-492-3566
Insurance Commissioner Poizner Clarifies that State Law Continues to Require Insurance Coverage for Breast Cancer Screenings
California Insurance Commissioner Steve Poizner today reminded Californians that a state law remains in place that dictates women still have the right under their insurance coverage to be given mammograms for breast cancer screenings beginning at age 35.
"Scientists can and should continue to research the best ways to treat our medical ailments," Commissioner Poizner said. "However, regardless of what recent medical panels have said, state law continues to require insurance companies to cover mammograms for women as early as age 35."
State insurance code currently dictates that women age 35 to 39 are entitled to a baseline mammogram. Women age 40 to 49 can get a mammogram every two years, or more frequently if their physician recommends it, and women 50 and older are to be provided a mammogram every year.
On Nov. 16, the U.S. Preventative Services Task Force reversed existing breast cancer screening recommendations and touched off a furious debate among insurance providers, doctors and patients. The Task Force said women should only get mammograms once every two years starting at age 50 instead of every one or two years at age 40, as had been the norm for decades.
The relevant section of state law can be found at: http://www.leginfo.ca.gov/cgi-bin/displaycode?section=ins&group=10001-11000&file=10110-10127.18
10123.81. On or after January 1, 2000, every individual or group policy of disability insurance or self-insured employee welfare benefit plan that is issued, amended, or renewed, shall be deemed to provide coverage for at least the following, upon the referral of a nurse practitioner, certified nurse midwife, or physician, providing care to the patient and operating within the scope of practice provided under existing law for breast cancer screening or diagnostic purposes:
(a) A baseline mammogram for women age 35 to 39, inclusive.
(b) A mammogram for women age 40 to 49, inclusive, every two years or more frequently based on the women's physician's recommendation.
(c) A mammogram every year for women age 50 and over.
Nothing in this section shall be construed to require an individual or group policy to cover the surgical procedure known as mastectomy or to prevent application of deductible or copayment provisions contained in the policy or plan, nor shall this section be construed to require that coverage under an individual or group policy be extended to any other procedures.
Nothing in this section shall be construed to authorize an insured or plan member to receive the coverage required by this section if that coverage is furnished by a nonparticipating provider, unless the insured or plan member is referred to that provider by a participating physician, nurse practitioner, or certified nurse midwife providing care.
Please visit the Department of Insurance Web site at www.insurance.ca.gov. Non media inquiries should be directed to the Consumer Hotline at 800.927.HELP. Callers from out of state, please dial 213.897.8921. Telecommunications Devices for the Deaf (TDD), please dial 800.482.4833.
If you are a member of the public wishing information, please visit our Consumer Services.