House Bill 297 creates insurance coverage parity for supplemental and diagnostic breast imaging in North Carolina. It recodifies and revises existing breast and cervical cancer screening coverage provisions to require health benefit plans to cover medically necessary diagnostic breast cancer exams and supplemental breast cancer exams, including breast MRI, breast ultrasound, and diagnostic low-dose mammography, when ordered by a treating healthcare provider. The bill also preserves existing coverage for cervical cancer screening and low-dose screening mammography, while defining the relevant imaging services and cost-sharing terms.
The bill further requires that cost-sharing for diagnostic or supplemental breast cancer imaging be no less favorable than the cost-sharing applied to low-dose screening mammography. It also adds a billing rule for out-of-network providers: a provider who has not contracted with an insurer must accept the insurer’s reimbursement amount, including patient cost-sharing, as payment in full for breast cancer prevention services, and may not bill the patient or seek extra reimbursement above that amount. The bill applies these insurance changes to policies issued, renewed, or amended on or after October 1, 2025, and extends the coverage mandate to the State Health Plan.
In state law, the bill recodifies G.S. 58-51-57 as G.S. 58-3-271, repeals related provisions in Chapters 58-65 and 58-67, and updates Chapter 90 billing rules by recodifying G.S. 90-701 as G.S. 90-705 and renaming the article to focus on transparency in healthcare provider billing practices. It also makes conforming changes to the State Health Plan statute so that the plan must follow the new breast cancer imaging coverage requirements.
The overall sentiment appears strongly favorable. The bill passed second reading in the House by a wide margin, 111-1, indicating broad bipartisan support for expanding access to breast cancer imaging and limiting patient cost barriers. No committee transcript is available, so there is no recorded floor or committee debate in the provided materials.
The main point of potential contention is the reimbursement and billing structure for non-contracted providers. The bill protects patients from balance billing for these services, but it also limits what out-of-network providers may receive and bars them from charging patients above the insurer’s reimbursement amount. Another possible issue is the interaction with high-deductible health plans and federal health savings account rules, though the bill attempts to preserve compliance with federal preventive-care requirements.
Impact
The bill amends North Carolina insurance law to require parity in coverage and cost-sharing for diagnostic and supplemental breast imaging, including MRI and ultrasound, and applies those requirements to the State Health Plan. It also changes provider billing law to prohibit balance billing for covered breast cancer prevention services by non-contracted providers and to require acceptance of insurer reimbursement as payment in full. The act recodifies and repeals several statutes in Chapters 58 and 90 to align the new coverage and billing framework, with most provisions effective October 1, 2025.
Sentiment
The available voting history shows overwhelming support, with the House passing second reading 111-1. That vote suggests the bill is viewed positively as a breast cancer access and affordability measure. Because no committee transcripts were provided, there is no detailed record of objections or amendments in the supplied materials.
Contention
The most notable contention centers on payment rules for out-of-network providers. Insurers and patient advocates may support the anti-balance-billing protections, while some providers may object to being required to accept insurer reimbursement amounts for breast cancer prevention services. A secondary issue is whether the mandated coverage and cost-sharing rules could affect plan design, especially for high-deductible health plans, though the bill includes language intended to preserve federal HSA compatibility.