June 26, 2017
Area(s) of Interest: Commercial Payors Patient Care
Anthem Blue Cross recently updated its preventive coverage policy on screening digital breast tomosynthesis (DBT or 3D mammography). Beginning with June 6, 2017, dates of service for individual, small group and large group health plans, 3D mammography for screening purposes will be covered at 100 percent, with no member cost share (copayments, deductibles or coinsurance). Anthem National Account plans will be updated to reflect this update beginning August 1, 2017.
This follows a February 2017 change Anthem made to archive its prior policy on 3D mammography, which deemed the procedure investigational and not medically necessary.
The change follows a very high denial overturn rate through claims filed with the Department of Managed Health Care’s Independent Medical Review process, where patients can challenge their plan’s denial that a service is investigational or not medically necessary. A class action lawsuit was also filed against Anthem earlier this year for its denials of 3D mammography.