Diagnostic Breast Imaging Insurance Coverage Lawsuits
Last Updated on November 3, 2025
Investigation Complete
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At A Glance
- This Alert Affects:
- Texas residents who paid a copay or out-of-pocket cost for a mammogram in the past six months and had health insurance at the time.
- What’s Going On?
- Attorneys working with ClassAction.org are looking into whether insurance companies are violating a Texas law by failing to cover 100% of the cost of mammograms. If so, it’s possible that class action lawsuits could be filed.
- How Could a Lawsuit Help?
- A class action lawsuit could help patients get back the money they spent out of pocket on mammograms. It could also force the insurance companies to ensure that such procedures are properly covered under their policies.
Attorneys working with ClassAction.org are looking into whether certain insurance companies have violated a Texas law by failing to cover 100% of the cost of mammograms—and whether class action lawsuits can be filed.
Specifically, under the Texas Insurance Code, certain health benefit plans are required to provide coverage for annual breast cancer screenings and, as of January 2022, diagnostic imaging for breast cancer. However, the attorneys believe some health insurance companies may have failed to update their practices, leaving patients on the hook for copays and other out-of-pocket costs associated with mammograms.
Are Mammograms, Breast Cancer Imaging Covered by Insurance in Texas?
Under the Texas Insurance Code, health insurance plans that cover females who are 35 or over must provide coverage for annual breast cancer screenings by low-dose mammography, an imaging method that uses X-rays to produce images of the breast called mammograms. The law requires coverage for both 2-D and 3-D mammography (also known as tomosynthesis).
As of January 2022, the Texas Insurance Code requires health insurance plans that provide coverage for screening mammograms to also provide coverage for diagnostic breast imaging, which is performed after a sign or symptom of breast cancer has been detected or on individuals with a history of breast cancer or dense breast tissue. Diagnostic imaging for breast cancer includes mammography, ultrasound imaging and magnetic resonance imaging (MRI)—the cost of which can range from hundreds to thousands of dollars without insurance.
How Could a Class Action Lawsuit Help?
A class action lawsuit could help compensate patients who paid out of pocket for mammograms in Texas. It could also force insurance companies to ensure that proper coverage is provided for breast cancer screenings and diagnostic imaging.
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