Florida insurer requires preauthorization for digital mammo

AuntMinnie.com staff writers

Dec 10, 2007

Florida Today is reporting that Brevard County's largest healthcare insurer, Health First Health Plans, is requiring women who want digital mammograms for breast cancer screening to first receive authorization from the company.

The newspaper quotes Shawn Farley, spokesman for the American College of Radiology (ACR), as saying the organization is "unaware of any other payor in any part of the country that is requiring preauthorization for digital mammography." He added that the ACR is looking into the insurer's policy.

The publication also cites Health First Health Plans' vice president and medical director Dr. Joseph Collins as saying the payment policy is based on a 2005 federal study that concluded digital mammography benefits women less than 50 years of age, premenopausal women, or women of any age with dense breast tissues.

He is quoted as saying the insurer believes it is "reasonable for us to require preauthorization -- to limit this technology to the age groups where there is clear benefit."

He said the policy, which has drawn the ire of at least one women's radiology center in Orlando, has rejected one or two elderly women to date.

Copyright © 2007 AuntMinnie.com

(A) Free-response receiver operating characteristic (FROC) curve for DBT-DINO and DINOv2 (Meta AI) on the detection task. DINOv2 achieved higher sensitivity than DBT-DINO across most false-positive thresholds. (B) Detection rates of DBT-DINO and DINOv2 for lesions that were ultimately found to be benign (n = 70) and lesions that were found to be cancerous (n = 66). Error bars represent 95% CIs estimated via patient-level bootstrapping with 1000 repetitions. Both models showed similar detection rates for cancerous lesions, whereas DINOv2 detected more benign lesions than DBT-DINO. (C) Example bounding box predictions for DBT-DINO and DINOv2 on the detection test set. Each image is a single two-dimensional section from a three-dimensional digital breast tomosynthesis volume; the first column shows a mediolateral oblique view, and the second and third columns show craniocaudal views. Both models struggled to detect very small lesions, such as the 3-mm-diameter lesion shown in the first column. FP = false positive.

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