Have you been denied coverage by your health insurance provider for supplementary imaging?
New Jersey women are legally entitled to insurance coverage for supplemental screening if they have extremely dense breasts or are at high risk for breast cancer. This provision is part of the New Jersey Breast Density Inform Act which became law on May 1, 2014.
Our friends at DenseNJ offer these suggestions for actions steps to take if you have been denied coverage:
Step 1: File an appeal with your insurance provider and be prepared to quote the law as follows:
Sections C.17B:26-2.1e and C.17B:27-46 of the NJ law (PL 2013 Chapter 196) state that individual and group health insurance policies are required to cover expenses incurred for an ultrasound evaluation, a magnetic resonance imaging scan, a three-dimensional mammography, or other additional testing of an entire breast or breasts for women with extremely dense breast tissue, if the mammogram is abnormal, or if the patient has additional risk factors for breast cancer including but not limited to family history of breast cancer, positive genetic testing, extremely dense breast tissue...or other indications as determined by the patient's health care provider.
Step 2: Contact the NJ Division of Banking and Insurance to file a complaint by phone or online
Call the consumer hotline and request assistance: 1-800-446-7467. They will answer your questions and guide you through the process. This agency has the power and the resources to investigate whether your insurance provider can legally deny your request for coverage.
Or complete the online complaint form which is available on the State of New Jersey website: http://www.state.nj.us/dobi/consumer.htm
Step 3: Send an email to firstname.lastname@example.org. If you are a patient of WDI, please copy us at email@example.com
There is a New Jersey advocate who should know about your denial. DenseNJ is compiling statistics in order to continue working with legislators and insurance companies to resolve this issue.