By: Kirsta Millar, Director of Policy
Over the past few months, VBCF has been fielding calls and emails to our office from patients with questions about Virginia’s new law aimed at removing cost as a barrier to early detection. The law prohibits state-regulated health insurance plans from charging out-of-pocket costs (co-pays, coinsurance, or deductibles) for diagnostic and supplemental breast imaging, including diagnostic mammograms, ultrasounds, and breast MRIs. The law officially went into effect on January 1, 2026. However, we are still hearing from some patients who have received bills for these services.
Recent coverage by WSLS 10 highlighted that some Virginians continue to receive bills they may not owe.
While some challenges with awareness of the new law were expected, we know it can be very frustrating to navigate health insurance coverage – especially when there is added anxiety about getting the follow-up or supplemental breast imaging recommended by your doctor. Our advice? Know before you go, understand your coverage, and don’t be afraid to advocate for yourself. See below for our recommendations.
Review VBCF’s FAQs About the New Breast Imaging Law
VBCF created an online resource page to help patients learn more about the law and determine whether it applies to them. Importantly, this law only applies to state-regulated health insurance plans. This most commonly includes insurance plans purchased through the Virginia Insurance Marketplace or if you are a state employee. If you get your health insurance through your employer, chances are your plan is not impacted by this new state law. Federal, out-of-state, and employer-sponsored insurance plans that are set up as “self-insured” do not have to comply with Virginia insurance laws. (That is why we need Congress to pass a similar law at the federal level to cover all types of insurance!)
Know Before You Go
Before your appointment, call your insurance plan to confirm whether you have a state-regulated health care plan covered by the law. If you do not, you may still be responsible for out-of-pocket expenses for certain types of breast imaging. As a reminder, all insurance plans must cover an annual screening mammogram at no cost to you.
What to Do If You Receive a Bill
If you do have a state-regulated health care plan and think you’ve been billed in error, here are some tips:
- If you receive a bill, don’t pay immediately. First, contact your health insurance company for clarification. Point out that you believe your plan is covered by the new law. Ask them to explain your policy, its benefits, and why you have been billed. You can file an appeal if necessary to ask them to reprocess the claim. It may be helpful to double-check the CPT (current procedural terminology) billing codes that were applied to your service. The law applies to diagnostic and supplemental breast imaging, but not biopsies or other testing.
- If your provider or imaging center asks you to pay upfront for a diagnostic or supplemental service, ask them to bill your insurance company first or to send you a bill after your insurance claim has been processed. Not all providers may be aware of the new law yet, and these services may no longer require an out-of-pocket cost for patients whose insurance plans are covered by the law.
- If you have exhausted all avenues with your health insurance plan and believe you are covered by the law, contact the Virginia Bureau of Insurance, Life and Health Consumer Services at 804-371-9691.
- Contact us for guidance. While we are not insurance experts, we can help you understand if the law applies to you and talk through your options for advocating for yourself. Contact: kirsta@vbcf.org
We’re Seeing Progress
We’re glad to report that several of the patients VBCF consulted with have successfully resolved their billing errors with their insurance carriers, including one bill totaling more than $3,000. The process took patience and persistence, but ultimately, patients had their claims refiled and corrected.
Six months after the new law took effect, VBCF is encouraged that many women are benefiting from the elimination of out-of-pocket costs for follow-up and supplemental breast imaging. We hope implementation of the law continues to improve as awareness grows among patients, providers, and insurers.
Passing the law was an important milestone, but making sure it works as intended is an ongoing effort. VBCF will continue to listen to patients, educate Virginians about their rights, and monitor how the law is being implemented. Our goal remains the same: helping ensure that every Virginian can access medically necessary breast imaging without financial barriers standing in the way.
