WellPoint to Cover Lung CT for Heavy Smokers

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Indianapolis-based insurer WellPoint is first out of the gate among the nation's insurers in deciding to cover low-dose CT screening for lung cancer in heavy smokers, company spokesperson Jill A. Becher confirmed to ImagingBiz today.

CT screening for lung cancer is recommended by the National Comprehensive Cancer Network, but is not yet recommended by the U.S. Preventive Services Task Force, the National Cancer Institute, the American College of Chest Physicians, the American Society of Clinical Oncology, and the American Thoracic Society. As a result, Medicare, Medicaid and all major private payors have up until now not covered the testing.

Despite this, many hospital radiology departments and diagnostic imaging practices have begun offering the test to their referring physicians and patients. This trend accelerated after the federally-funded National Lung Screening Trial found screening current and former heavy smokers with low-dose CT scans was tied to a 20% reduction in lung-cancer deaths.

To make the testing accessible, radiology departments and practices in many areas of the country have offered discount and in some cases free lung CT scans for heavy smokers -- a practice that has drawn some controversy. In August, the influential Kaiser Health News ran a story on the trend that also pointed out that hospitals stand to benefit from the follow-up diagnostic testing and cancer treatment some patients who receive the lung CT screening tests will need. There was also the issue of exposing patients to radiation in a screening exam that is not yet recommended by preventive health and cancer treatment groups.

WellPoint plans to cover people who match the characteristics of those involved in the National Lung Screening Trial. Among other traits, this means that they smoked at least the equivalent of a pack a day for 30 years and are 55 to 74 years old.

In an article on the development, the Wall Street Journal contacted other major insurers, including Cigna, Aetna and UnitedHealth Group, all of whom said they are not covering the screening test.

WellPoint is one of the nation’s largest health benefits companies, with 34 million members in its affiliated health plans, and a total of more than 66 million individuals served through its subsidiaries. According to company information, it is also an independent licensee of the Blue Cross and Blue Shield Association, and as such serves as the Blue Cross licensee for California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin.