- Describe your topic.
- The issue is that a breast ultrasound as a diagnostic service with a mammogram as a preventative service could be a barrier to access to care due to the high cost of financial responsibility. The question is how many women with dense breast do not have ultrasounds due to the ultrasound not being a preventative service at 100% coverage.
- Describe why this topic is important.
- This topic is important because this specific population of women with dense breast should not have this type of barrier to an early detection of breast cancer. This population of women should not have to make a decision due to financial restrictions that can make a difference between Life and Death. In Connecticut, about 10% of women receive ultrasounds. Currently, research has shown that Connecticut is one of the highest diagnosed stated with breast cancer. Maybe there is a correlation.
- Tell us why you are suggesting this topic.
- As nurses in the Office of the Healthcare Advocate, State of Connecticut, we routinely receive calls from women with this condition that have either declined having their ultrasound when they found out their financial responsibility. Many of the woman did not know the financial responsibility until after the service provided. Then decided going forward that the ultrasound would not be part of their yearly check up. The purpose is to determine if breast ultrasounds after mammograms should be covered by insurance as a preventative standard of care. Physicians routinely order ultrasounds with yearly mammograms for this population of women with dense breast.
- Target Date.
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- Our office assist members by researching their insurance health care plan and state/federal mandates which will define how much the consumer will need to pay. If this is the first time that the consumer has encountered a bill for the ultrasound with a yearly mammogram, our office is usually successful in getting a one-time exception approved by the healthcare insurance carrier. After this one-time exception, the member is considered educated. Going forward, the member will be financially responsible for all future ultrasounds with their yearly mammograms. Our office will request an 1 time exception for coverage from the insurance carrier and educate the member on how their healthcare plan will provide coverage going forward. This is a "band-aide" and does not provide ongoing preventative services that this population requires to combat breast cancer.
- How will you or your group use the information from a new evidence report?
- Our office identifies issues, trends and problems that may require executive, regulatory or legislative intervention. Therefore we can bring this information to a legislative level to propose change to the current laws regarding preventative services by developing a guideline policy that will incorporate a standard of care already in practice by providers. Our office develops collaborative efforts with other agencies, organizations and identified specialty entities to educate consumers.
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- Our office would plan to disseminate this information from the report to the legislative body to review implementation of change to the insurance criteria. The dissemination of information would be in a presentation format to healthcare providers, health organizations, cancer organizations, and identified professional entities.
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- Our agency is considered the "healthcare insurance watchdogs". We work with many stakeholders such as patient advocacy organizations, healthcare organizations, hospital associations, cancer organizations, many consumer non-profit healthcare organization and other healthcare insurance advocate. Our standard of moving information forward is to develop collaborative unities to educate the public and let their voice be heard.
- Information About You: (optional)
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- Provide a description of your role or perspective.
- Advocate for members of healthcare insurance
- If you are you making a suggestion on behalf of an organization, please state the name of the organization.
- Office of the Healthcare Advocate
- Please tell us how you heard about the Effective Health Care Program.
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