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Nurse Assisting Patient Undergoing Mammogram

Breast Cancer Screening: Who Profits from Early Detection?

  |   By Elisabeth Dale

When Angelina Jolie revealed she carried the breast cancer gene, the world learned about the $3,000 price tag attached to BRCA testing. But gene mutations represent a small percentage of breast cancer cases, and 85% of women diagnosed have no family history of the disease. Who pays for their breast cancer screening?

Since women rely on mammography as their primary early detection tool, most insurance plans cover routine mammograms.

 

Yet a recent survey found that mammography charges vary widely at clinics and hospitals. Early detection is big business, with some 37 million mammograms performed in the US each year. Most cancer organizations recommend that women over 40 be screened every one to two years, and in some cases, earlier and more often. I had my first mammogram at age 30. I was told my mother’s pre-menopausal diagnosis put me at higher risk. I didn’t think to question this advice. Besides, the yearly screenings were covered through my insurance.

 

So imagine my surprise when I got a $1,400 bill for my most recent mammogram, and my health insurance carrier refused to pay any part of the claim.

 

In the fall of 2012, I scheduled a mammogram at Seattle Cancer Care Alliance. I’d used their imaging facility before, and had interviewed their breast cancer specialists for my book. My over two decades of mammographic records were stored on their computer system. It was easier than finding a new provider in Los Angeles or having my files transferred. Plus, when I called to set up the appointment, SCCA assured me that my out-of-state insurance would cover the cost.

 

I arrived mid-morning and was given the usual paperwork to fill out. One of the questions asked if I’d experienced any breast pain over the past year. I checked “yes,” to acknowledge soreness in my left breast where scar tissue from my breast lift was irritated by weight training. I figured it would cue the technician to be more careful during my exam. I was also questioned about my exposure to chest radiation. I marked that one “yes,” too. I wanted the record to reflect my 26 years of annual mammograms.

 

Within five minutes of turning in the completed form, I was ushered into a private office for an unexpected individual consultation. The clinic employee spoke in hushed and cautious tones as she told me my file had been “flagged.” I was no longer eligible for a routine mammogram. Why? Because I had reported breast “pain.” The young woman explained I would have to have a diagnostic procedure (mammogram with extra, more precise views), and an ultrasound. But they couldn’t schedule this more complex screening without a physician’s referral. I was flying back to LA the next day and assured her a routine mammogram was good enough for me. I was told that was no longer an option. But she would check to see if she could get one of their clinicians to examine me that afternoon and order these additional diagnostic procedures.

 

I spent the rest of that day at SCCA, my boobs held hostage to their medical system. First, I waited to see their breast specialist. She walked me through a computer program and informed me of my higher than average risk of breast cancer. (Yep, getting older and being female do increase risk.) Not high enough to have a mammogram more than once a year, but I should come back every six months for a clinical evaluation. Second, she admonished me for checking off the “previous radiation” box on the intake form. My 26 years of mammograms didn’t count, but my pain sure did.

 

Her clinical exam found no abnormalities and she signed off on the required referral. I thought to myself, “what the hell, I’m here and it’s covered.” Besides, all the urgency had me questioning my own beliefs. What if they were right and I was wrong? I know more about breast health than the average woman but their concerns had me filled with doubt. I went through with the diagnostic mammogram and breast ultrasound. The result? My pain was due to irritation of the scar tissue above my injured pectoral muscle.

 

I’m still wrestling with SCCA over who is responsible for the balance of my bill, around $950. But I’ve found that I’m not alone. Reading through these comments on a medical billing site introduced me to the plight of others suffering from breast cancer screening sticker shock. Many women don’t know the difference between a routine and diagnostic procedure, or which ones are covered by insurance. Some aren’t aware that prices vary by area or facility. Others don’t know that resources exist for those who are uninsured or need free mammograms.

 

I’ll be more careful in the future when filling out breast imaging intake forms. I’ll never again let a medical facility tell me what’s covered by my insurance. I’ll check it myself, first. I’m going to trust my instincts about what’s right or wrong when it comes to my body, as did my mother. And I’ll continue to question whether I needed all 27 of my own mammograms.

 

What do you think? Have you ever been confused by recommended mammography procedures? Should providers be more consistent in setting routine breast cancer screening costs?

 

Featured Image: iStock Photo

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