Roanoke, VA – Three women in our region received unexpected bills for breast cancer screenings despite a new Virginia law designed to eliminate out-of-pocket costs for those services.
After viewers Debbie and Lynn reported receiving bills of $300 and $600, respectively, Roanoke resident April reached out saying she was billed $971 for a diagnostic mammogram and breast ultrasound.
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“On July 2, I had a diagnostic mammogram and a breast ultrasound. My insurance company billed $1,867 and I was billed $971,” said April. “My only aunt was diagnosed with breast cancer at 45 and passed away from breast cancer. This is an incredibly personal issue for me.”
The bills — and dozens of viewer comments — prompted a closer look at the law and the questions surrounding it.
Law covers diagnostic exams, not just routine screenings
Julian Walker, Vice President of communications for the Virginia Hospital & Healthcare Association, sat down to address some of the most common viewer questions.
One of the biggest questions: Does the law cover diagnostic exams, or only routine screenings? Walker says it covers both — but only for health plans regulated by the state.
“Diagnostic mammograms, breast ultrasounds, breast MRIs — under the law, state-regulated health insurance plans are prohibited from charging things like copays, coinsurance, or deductible fees for those kinds of services,” Walker said.
‘Medically necessary’ language leaves room for interpretation
Even when a plan is state-regulated and the service appears to be covered, the law’s own language may create gray areas. The law defines a diagnostic breast examination as “medically necessary and appropriate” — a phrase that can be interpreted differently depending on the case.
That ambiguity is part of why some women on covered plans may still find themselves facing unexpected bills.
“There are exceptions to the law, which is important for people to understand,” Walker said.
Some plans may not be covered until July
Another frequently asked question involves insurance plans that renew in July. The Virginia Breast Cancer Foundation confirmed the law does not apply until July 1 for some plans.
Walker pointed to the law’s language, which states it applies to “health care services delivered, issued for delivery, or renewed in the Commonwealth on and after January 1, 2026.”
“I wouldn’t want to speculate on that, but that is the language that is in the law,” Walker said.
How to find out if your plan is covered
Viewers also want to know how to determine whether their plan falls under the law. Walker acknowledges that calling your insurance provider is never fun — but says it is worth doing before your appointment rather than after.
“They can always call their insurance company ahead of time and just make sure. ‘I’m getting this service; I’m getting it through this provider. I want to make sure that this is a service that is consistent with the provisions of the new law,’ which means that that patient would be spared from that copayment or that coinsurance,” Walker said.
The best approach: Know before you go. Before scheduling a breast cancer screening, call your insurance provider, confirm your plan is state-regulated and ask whether the services you need are covered under the law. Speaking with your provider before your appointment means you’ll know exactly what’s covered — and could save you hundreds of dollars.
If you’re unsure whether your bill is valid, the Virginia Breast Cancer Foundation has a simple but important piece of advice — don’t pay it yet. It can take far longer to get a refund from an insurance company than it does to make a phone call to sort out the issue before any money changes hands.
Already paid? Here’s what to do
If you’ve already paid a bill, you believe should have been covered, visit the resources below for assistance.
Lynn and April are still working with their insurance companies to recover the money they paid. Debbie’s situation went a step further — after attempts to resolve the issue directly with her insurance provider were unsuccessful, she filed an appeal with the Virginia Bureau of Insurance and received her money back. 10 News is working with Lynn and April to navigate the situation.
Resources
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 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.