Georgia House Bill HB928

Georgia 2025-2026 Regular Session

• Introduced: 4/4/25

Caption

Insurance; utilization review by an insurer shall not be required in the instance in which a physician has determined the existence of dense breast tissue and the medical necessity of a breast ultrasound; provide

Impact

If passed, HB 928 would have a significant impact on the state's healthcare policies by ensuring that patients with dense breast tissue receive timely access to breast ultrasounds without undue barriers from insurers. The bill emphasizes the need for cost-sharing requirements for these diagnostic examinations to be no less favorable than those applied to standard mammograms. This change would encourage health insurance providers to cover essential preventative care more equitably, improving health outcomes for women at risk of breast cancer.

Summary

House Bill 928 aims to amend insurance guidelines concerning breast cancer screenings, specifically regarding the utilization review process. The legislation stipulates that when a physician has identified dense breast tissue and determined that a breast ultrasound is medically necessary, insurers will not be required to perform a utilization review, which is typically a process to assess the necessity and efficiency of healthcare services. This move is intended to facilitate better access to necessary diagnostic tools for patients with dense breast tissue, who are at a greater risk for breast cancer and may require additional imaging beyond standard mammography.

Contention

There may be points of contention surrounding this bill, particularly from insurers who may argue that loosening utilization review requirements could lead to higher costs and potential overuse of services. Supporters of the bill, however, maintain that it addresses a crucial gap in breast cancer screening for women with dense breast tissue. Critics might also be concerned about how this could influence insurance coverage policies overall and whether such exceptions might lead to differing standards of care across insurance plans, potentially exacerbating inequalities in access to care.