Renee Hinson remembers the battle last year to get her insurance company to cover genetic testing as she was being treated for breast cancer. When the University Hospital Breast Health Center finally got approval, it turned out she had a BRCA2 mutation that put her at higher risk of ovarian cancer as well, and caused her to have her ovaries removed six weeks ago.
“Had I not had the test, I might be walking around with the start of ovarian cancer if I kept my ovaries,” Hinson said. The fact that such testing will be required under policies sold under the state Health Insurance Marketplaces that open enrollment Tuesday is good news to her.
“That will be great,” she said.
The start of Breast Cancer Awareness Month Tuesday also coincides with the beginning of open enrollment under the Affordable Care Act. Policies sold through the marketplaces, also called insurance exchanges, must cover a wide variety of preventive services that must be provided without a co-pay. That includes genetic testing for mutations in the BRCA genes for high-risk patients because those mutations increase the risk of breast cancer and ovarian cancer. Policies would also have to cover annual mammograms for women over age 40 and for chemoprevention for women at higher risk of breast cancer.
This year, 234,580 will be diagnosed with breast cancer and 40,030 will die from it, according to the American Cancer Society. For the 7,310 women that will be diagnosed in Georgia, those without insurance and earn 200 percent of the Federal Poverty Level or less might get coverage through Medicaid, according to the Georgia Department of Community Health. But whether they can get genetic testing is often iffy, said Pam Anderson, cancer services program coordinator for University. She has one lady whose test was submitted for approval Aug. 1 who is still waiting on her insurance company to sign off on it.
“This is a lady with breast cancer that the outcome of this could change her surgical decision,” Anderson said.
Even mammograms are not routinely covered for many patients with insurance, she said.
“The issue that really we have is not so much the uninsured as the underinsured,” Anderson said. “There are still insurance companies out there that don’t pay for mammograms. There are people that have high deductibles and they have to meet their deductible first.”
In the case of the BRCA mutations, it is that increased risk of ovarian cancer that becomes critical, Anderson said. Ovarian cancer is much more difficult to detect than breast cancer.
“That’s the scariest part to me,” Anderson said.
In Hinson’s case, genetic testing led to additional treatment and caused increased vigilance for her two daughters, ages 15 and 25. She now is part of a support group through Facebook and often talks to women who were in her same situation, Having the test available without a fight in the new policies is music to her ears.
“That will be great,” Hinson said. “It’s a big battle for a lot of women getting them to cover that test.”