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Law Against "Drive-Through" Breast Cancer Surgeries Coming Soon?

By Javier Lavagnino, Esq. on May 20, 2009 | Last updated on March 21, 2019

The Breast Cancer Patient Protection Act of 2009

Legislation was recently introduced in Congress that would force insurers to pay for a minimum hospital stay for patients undergoing certain types of breast cancer treatment. If the Breast Cancer Patient Protection Act already sounds familiar, it might be because such legislation has been lingering around in consideration and debate, in various forms, for over a decade.

The proposed legislation is aimed at the issue of "drive-through" breast cancer surgeries, and how insurers sometimes try to limit coverage for such surgeries (even mastectomies, or the removal of breasts) to outpatient procedures. In other words, sometimes insurers will only pay benefits on those surgeries to the extent they are outpatient procedures, and might not pay for a patient's hospital stay.

However, the legislation suggests there have been reports of adverse effects due to early hospital discharges after breast cancer surgeries, including infection and uncontrolled pain. This might be why twenty states already have laws requiring coverage for a minimum of inpatient treatment after a mastectomy, but the states' varying laws just add to the confusion for health care providers who might provide breast cancer treatment for patients from various states. To address this, the federal legislation would equalize coverage across the nation and require insurers to cover at least 48 hours of hospital stays related to breast cancer procedures such as mastectomies and lumpectomies.

Insurance industry groups have, not surprisingly, already voiced their displeasure with similar legislation as follows, per a Reuters story last year:

"... America's Health Insurance Plans, an industry group for most major health plans such as UnitedHealth Group and WellPoint Inc, called the bill unnecessary.

'We do not think that it is a good idea on the state level or the federal level to be putting clinical guidelines into statute,' group spokeswoman Susan Pisano said.

Most health insurers treat each case on a 'medical necessity' basis. 'We think there are women who are satisfied with shorter lengths of stay,' she said."

Notably, however, there is nothing in the legislation requiring that patients stay 48 hours or longer, it simply requires coverage should that choice be made by patients and doctors. Indeed, physicians' groups such as the American Medical Association (AMA) simply have argued that it's crucial to allow medical decisions to be made by patients and doctors, as opposed to insurers. Only time will tell whether this latest attempt at the legislation will bear fruit, considering how much difficulty it has had to date.

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