Thursday, May 31, 2012

As I mentioned in my last post, health insurers—and legislators sympathetic to insurers—don't like the insurance requirement in S6769/A9586. They're trying to amputate that arm of the bill.

Even the American Congress of Obstetricians and Gynecologists (ACOG) claims to oppose the bill because it has an insurance requirement. They say it's unnecessary: "Currently, ACOG is unaware of cases whereby women are unable to get additional breast imaging if her physician believes the mammography result warrants further investigational study."

ACOG, you're about to get schooled. But before I school ya, let me tell you why ACOG's argument smells.

In California, similar legislation died last year (only to come back from the dead...only to be murdered at the governor's desk...only to be resurrected yesterday but I'll get to all this in another post.) The difference between the California bill and the New York bill is that the California bill does not have an insurance requirement.

The California Medical Association (CMA) fought hard against the bill last year because it did not require insurers cover additional screening. The chairwoman of CMA's legislative council, Ruth Haskins, complained that women requesting additional screening would end up frustrated because insurance wouldn't cover these screenings: "The problem with this bill is that it gives a boatload of power to a lot of women who then become powerless to use that information."

So in California, doctors' orgs oppose the bill because insurance won't cover additional screenings, and that will frustrate women. In New York, doctors' orgs oppose the bill because it requires additional screenings and you can't prove that's necessary.

There's a saying for this: damned if you do and damned if you don't. In fact, there's a word for this: catch-22.

It's Kill da Bill, East Coast Style vs. West Coast Style.

The truth is, these doctors' orgs don't care if insurers cover additional screenings or not. (Note that ACOG is not arguing that the insurance requirement be removed from the bill; they just cite it as a reason to oppose the bill in its entirety.) ACOG would oppose this bill regardless, and will come up with whatever they can think of to oppose it.   Because this is all about control of information for them.  Doctors reflexively chafe at being told what to do by legislators. ACOG opposes requiring doctors to share vital information with their patients, even if doing so will save patients' lives.

(Note that there are good gynecologists and obstetricians out there. There are even good local orgs representing these specialties. However, their national organization stinks.)

But as long as they've put this bogus argument out there, let me address it. It's the same thing you'll hear if you call Assembly Insurance Chair Joe Morelle's office: do you know of a single case where a woman has been denied coverage for a screening sonogram? It's kind of a trick question, because at present there's no insurance code for a screening sonogram--only a diagnostic sonogram. That means if a woman has dense breasts and wants a sonogram, she (possibly with her doctor in cahoots) has to lie fib and claim there's an irregularity so she can get a diagnostic sonogram.

So we had no evidence that insurers wouldn't cover a screening sonogram because to date there's no such thing as a screening sonogram. We had nothing to give them.

Until a day ago. A lady in Poughkeepsie--and I don't know who she is or how we found her--had dense breasts and requested a sonogram. Her doctor ordered one. And her claim was rejected by her health insurer. She forwarded it to supporters of the bill.

This documentation was forwarded to Joe Morelle's office. Word on the street is that it was a hot topic of discussion in Morelle's office yesterday.  But not everyone in his office got the memo, because a constituent of Morelle's who called his office today was told "we have no cases of a woman being denied access to additional tests when the doctor has determined that they're necessary."

You do now.

Right now, we're so down to the wire that I will be relieved if the bill makes it out of Morelle's office at all, even if the insurance arm is amputated. We're really short on time here.

(That doesn't mean I will be happy. It will be a shame if the insurance requirement is removed from the bill--a shame on the insurance committee.)

However,  if the bill leaves Morelle's office with the insurance arm intact, we can thank that lady in Poughkeepsie...and the dumb bureaucrat who denied her sonogram claim. P.S. ACOG, you've been schooled.


  1. In principle we can sympathize (can't we?) with a professional wish not have one's professional judgment restricted by legislators. As a university teacher I resent the paternalism of the "Higher Education Council" of the country where I work and live. And yet I have seen that at least some of the central control of this authority was instituted for a reason. Sometimes the professionals need "reminding" of their responsibilities.

    1. Yes, they are definitely not meeting their responsibilities. Federal law already requires that radiologists send patients a summary of their mammogram report in clear language (since the patients don't see the actual report). The American Congress of Radiologists is not complying with the law, since normal is not a synonym for unreadable (the letter to patient says "normal" while the report says difficult to read. Radiologists are omitting information required for a patient to give required consent. Gynecologists want radiologists to continue omitting this information for various reasons, none of which have to do with concern for the patient.

  2. Its a little bit different with Doctors because they are held to standards of care which are actionable in the courts should they fail to meet that standard of care. Thus in principle it is a proper exercise of state power to legislate standards and duties of care. If the evidence justifies it, as it does in this case, it is proper for the state to decide they want to double detection of women with dense breast, as was done in CT, rather than leave it to the tort system and courts, which can only act after the harm is done.