This bill requires health care professionals to order bi-lateral ultrasounds concurrently with mammograms for women undergoing breast cancer screening, ensuring comprehensive diagnostic procedures are accessible without additional financial burden. It mandates that insurers provide coverage for both mammograms and the concurrent ultrasounds, amending existing laws to include this requirement. The new language specifies that insurance contracts must cover ultrasound evaluations, magnetic resonance imaging scans, three-dimensional mammography, or other additional testing of the entire breast or breasts when ordered alongside a mammogram by a health care provider.

Furthermore, the bill stipulates that health care providers involved in breast cancer diagnosis or treatment must order these additional tests for women with specific risk factors. It ensures that health insurers cover these tests when ordered concurrently with a mammogram, extending the coverage requirement to various health plans, including those from health maintenance organizations and the State Health Benefits Program. The bill also includes provisions for utilization review of the medical necessity of these additional screenings and sets an effective date for the first day of the fourth month following its enactment, applying to all relevant contracts and policies issued or renewed thereafter.

Statutes affected:
Introduced: 17:48-6, 17:48A-7, 17:48E-35.4, 17B:26-2.1, 17B:27-46.1, 17B:27A-7.10, 17B:27A-19.13, 26:2J-4.4, 52:14-17.29