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What will I pay for supplemental dense breast imaging?

Understanding Copays, Deductibles, and Coinsurance

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Insurance Coverage for SOFIA 3D Breast Ultrasound

More than 35 states and Washington, D.C., have passed laws expanding insurance coverage for supplemental SOFIA 3D breast ultrasound exams, and a growing number now prohibit or significantly limit out-of-pocket costs such as copays, deductibles, and coinsurance. However, coverage rules can still vary by state and insurance plan.

Insurance Plans That May Be Exempt

Even in states with strong breast imaging laws, some health plans are not covered. Patients with these plans may still have out-of-pocket costs:

Large self-insured employer health plans
Government employee health plans
Church or religious organization plans
Out-of-state insurance plans (You live in one state but work in another)

Always check your specific plan to understand your coverage.

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Who Qualifies for Supplemental Breast Imaging?

State laws that lower costs do not guarantee that everyone will qualify. Eligibility often depends on medical need and risk factors, such as:

A healthcare provider’s recommendation
Breast density:
Extremely dense (BI-RADS Density D)
Heterogeneously dense (BI-RADS Density C)
Inconclusive mammogram results (BI-RADS 0)
Higher breast cancer risk
Family genetics and breast cancers
Personal and family medical history

Supplemental vs. Diagnostic Breast Ultrasound

Breast imaging laws do not always cover the same types of exams.

Supplemental breast ultrasound is often used for women with dense breasts or higher risk
Diagnostic breast ultrasound is used after an abnormal mammogram or when more testing is needed

Some states cover both types, while others only cover supplemental exams. SOFIA 3D breast ultrasound can be used in both cases. Your healthcare provider must write the referral appropriately. This helps reduce possible out-of-pocket costs.

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Help from SOFIA Patient-Friendly Imaging Centers

If your insurance is not covered by state law, you may still have costs like copays or deductibles. While insurance rules cannot usually be changed by a clinic, some imaging centers may offer:

Payment plans
Financial assistance
Discount programs

These options can help make care more affordable.

SOFIA’s Recommendation

To avoid surprise medical bills, contact your local SOFIA 3D breast ultrasound imaging center before scheduling your mammogram or supplemental ultrasound.

They can help you:

Understand your insurance coverage
Estimate out-of-pocket costs
Learn about payment options

Planning can help you feel more prepared and avoid unexpected expenses.

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SOFIA, your answer.

Discover how SOFIA transforms breast cancer imaging with rapid scans, accurate results, and a patient-friendly experience.
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