3D Breast Tomography Not Covered for USFHP Members

May 25, 2018

The Washington State Senate recently passed legislation that requires all private insurance companies to cover breast tomosynthesis, also called three-dimensional (3D) mammography and digital breast tomosynthesis (DBT).

This legislation does not apply to federal programs, and USFHP falls under the federal regulations. USFHP members seeking this service are required to sign a “Waiver of Non-Covered Services” form, and USFHP network providers must inform beneficiaries in advance that 3D mammography is not covered by USFHP.

PacMed’s contract with the Department of Defense will not permit it to reimburse network providers for non-covered services. The signed waiver confirms that the beneficiary has agreed in advance to be financially responsible for any portion of the encounter/service that is not covered. Providers must keep copies of all signed beneficiary waivers.

The Department of Defense may establish 3D mammography coverage at some point, but we have received no indication this will happen in the near future.

If you need assistance, please contact USFHP Member Services at (800) 585-5883, option 2.