Beyond the mammogram: Paying for peace of mind

LANSING, Mich. (WOOD) -- While Michigan doctors will soon have to release breast density information to women, how patients pay for follow-up tests -- should they decide to get further screening -- is still up in the air.

A recommended yearly mammogram may not always detect cancer in women who have dense breast tissue. Women who learn their breast tissue is dense may want further testing to ensure they don't have cancer.

But that extra testing can be expensive. The question often becomes this: 'How much is peace of mind worth to you?'

Laurie Lucas said she never had a choice. She got her first annual mammogram when she turned 40 and never missed one.

But what several mammograms missed could now kill her.

Lucas didn't know she had dense breasts and the fibrous tissues makes it harder for a mammogram to spot cancer.

"If I had known that, I would have pushed for an ultrasound then. But nobody ever told me that," Lucas said.

Lucas had an abnormal mammogram in 2013. Her doctor ordered another mammogram and an ultrasound. After the second mammogram was considered 'normal,' her doctor canceled the ultrasound.

"You trust what your doctor tells you," Lucas said. "If a doctor comes out and says, 'We don't need to do further testing. You're fine,' you believe that."

Now, less than two years after her doctor cleared that second mammogram and canceled the follow-up ultrasound, Lucas has stage four breast cancer, which has metastasized -- it's spreading.

Laurie Lucas, who developed breast cancer that wasn't caught early enough due to her dense breast tissue.

"I'm going to lose my life because of their mistake. And that's pretty hard to take." —Laurie Lucas, a breast cancer patient

New state legislation aims to prevent another story like Lucas'. Michigan's dense breast notification law, which goes into effect June 1, requires doctors to tell their patients if they have dense breasts and explain what that means.

But that's as far as the legislation goes. There's no guarantee insurance will then cover further testing.

"Then you have to decide, can I afford to pursue this? And if you can't afford to pursue it, what are you left with?" Richard Murdock, the executive director of the Michigan Association of Health Plans said.

Richard Murdock, the executive director of the Michigan Association of Health Plans.
(Murdock.)

His nonprofit is an advocate for affordable and accessible health care in Michigan.

Murdock said even if you learn you have dense breasts, you may have to pay for further testing out of your own pocket.

He said doctors and insurance companies are waiting to hear what added tests the U.S. Preventive Services Task Force and American Cancer Society consider effective.

Murdock urges patients to investigate, have appropriate conversations with their primary care providers and make sure those providers are communicating with radiologists and other specialists so patients are able to make informed decisions about additional tests. Otherwise, patients may be surprised when they get the bill for added tests they requested.

Target 8 examined the costs of added tests including a breast ultrasound, tomosynthesis or 3-D mammogram, and a breast MRI.

According to Healthcare Blue Book, the fair price of a breast ultrasound in West Michigan is roughly $130.

Mercy Health says a 3-D mammogram runs about $150.

What's considered the most comprehensive test is also the most expensive, Target 8 found. The fair price of an MRI costs nearly $1,400.


"If they go forward without consulting with their provider or insurance company, that may result in terms of out-of-pocket expense and that's unfortunate. We don't need to go there." —Richard Murdock, MAHP executive director

Several states have already passed laws requiring insurance companies to pay for breast ultrasounds for women with dense breasts.

Murdock said Michigan isn't behind the ball. He pointed out if Michigan lawmakers require insurance companies to cover additional tests, taxpayers could end up paying for those extra services.

"Under the Affordable Care Act, if you do add additional mandates to a benefit package that go beyond the services that are required, then it's the obligation of the state to fund that at 100 percent. Then it becomes a state cost," said Murdock.

If a patient is willing to pay out of pocket, they should do their homework. Target 8 has shown there are cost variances from facility to facility in West Michigan.

According to Healthcare Blue Book, the cost of a breast MRI in West Michigan ranges from $938 to more than $3,806.

You can file with the State Insurance Commissioner if you believe your insurance company should have to pay for certain tests.

The Insurance Commissioner will review your concerns and has the final say on whether your insurance company should pay up.

 

Resources

Healthcare Blue Book

State Insurance Commissioner

Online:

A GoFundMe account for Lucas

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