LYNCHBURG, Va. – A new Virginia law is designed to eliminate out-of-pocket costs for breast cancer screenings — but some patients are still receiving unexpected bills, and many don’t know they don’t have to pay them.
The law, which took effect Jan. 1, 2026, prohibits state-regulated health insurance plans from charging copays, coinsurance or deductibles for diagnostic and supplemental breast imaging, including diagnostic mammograms, ultrasounds and breast MRIs.
Lynchburg patient surprised by $300 bill
Debbie Farrago of Lynchburg said she had a routine mammogram and was told at the front desk that a follow-up ultrasound would be covered at no cost.
Weeks later, a bill for more than $300 arrived. Farrago says the charge was tied to her insurance deductible. Centra was the facility where she received care, but the billing determination was made through her insurance provider.
“And I said, ‘Hey, you know, why am I getting billed this when they told me at the desk I shouldn’t?’” Farrago said.
It took her months and hours of research and phone calls with her insurance provider to get the charge removed.
“Why is it not being filed, and why do we even have to go through this first of all?” she said.
Farrago said she worries others across Virginia are quietly absorbing costs they were never required to pay.
“I think a lot of people might not even know. So, they would just pay it,” she said.
Second patient comes forward
After Farrago’s story was first reported, another local patient reached out with a similar experience.
Lynn, who asked that her last name not be used, is waiting to schedule surgery to remove a cancer found during a diagnostic mammogram. On top of her health concerns, she is facing a bill she didn’t expect to receive.
“My balance is $623.15,” she said.
Navigating the health care system while managing a serious diagnosis has taken a toll.
“So, navigating the system of health issues, like it gets overwhelming. Because you, you know, the tests need to be done. But in the back of your mind, you’re like, costs, like, what am I paying?” Lynn said.
And Lynn is not alone. According to the Brem Foundation, 1 of 3 women name cost as a factor for why they do not plan for breast cancer screenings.
Lynn was connected with Kirsta Miller, director of policy at the Virginia Breast Cancer Foundation, for guidance on next steps.
“Health insurance can be complicated and confusing, and navigating the bills and the things that you’re getting in, your explanation of benefits and all those things can be difficult,” Miller said.
Lynn said the experience reinforced how important it is to speak up.
“If I had not advocated for my own self, then I wouldn’t be where I’m at now,” she said.
According to the Virginia Breast Cancer Foundation, many patients have already paid bills they were never required to pay.
Not all insurance plans are covered
The Virginia Breast Cancer Foundation, which helped advocate for the legislation, says the new law comes with an important caveat — it does not apply to every insurance plan.
The law covers only state-regulated health insurance plans, which most commonly means plans purchased through the Virginia Marketplace. Patients who receive health insurance through an employer are likely not covered, as federal, out-of-state and employer-sponsored self-insured plans are not required to comply with Virginia state insurance laws.
“VBCF knew there would be a learning curve in terms of awareness of the new breast imaging law,” the organization said in a statement.
To help patients navigate the new rules, the foundation created an online resource page with detailed information about the law and guidance on whether it applies to a specific plan.
What patients should do
The Virginia Breast Cancer Foundation recommends that patients take the following steps:
- Before your appointment: Call your insurance provider and confirm whether you have a state-regulated health care plan covered under the new law.
- If you receive a bill: Do not pay immediately. Contact your insurance plan first, point out that you believe your plan is covered by the new law and file an appeal if necessary.
- If asked to pay upfront: It is acceptable to ask the provider to bill your insurance company first or send a bill later. Providers may not yet be aware of the new law.
- If all else fails: If you have exhausted all options with your insurer and believe your plan is covered, the Virginia Bureau of Insurance may be able to help resolve the situation. The number is 804-371-9631.
Farrago said her experience reinforced the importance of pushing back.
“Reach out for help to organizations that can help you out with it and be your own best advocate for sure,” she said.