A breast cancer diagnosis is scary, and the test to find out if you have it could cost you thousands, even with health insurance. That has a lot of women skipping their screenings.
Women are told to have mammograms annually, but only if you’re over 50. Still, breast cancer concerns exist for everyone.
Dr. Tasleem Padamsee, faculty affiliate at The Ohio State University’s James Comprehensive Cancer Center, hears story after story.
“I remember a particular woman telling me the story of her care provider telling her, ‘Well, really you should be getting these MRI, but I don’t know if you want to do that, because it’s really expensive.’ And she said, ‘Well, will my insurance cover it?'”
The answer was no. But in this case, the woman wanted to move forward anyway, Padamsee said.
“She called to make an appointment. And they said it’ll actually be $3,500.”
Another woman told Padamsee she wanted a preventative mastectomy because her BRCA gene mutation puts her at a high risk of developing breast cancer.
“They couldn’t convince the insurance company that it was a preventive procedure. And all of the physicians involved said it’s a preventive procedure.”
With a price tag of $20,000, the woman is still looking for help.
Padamsee’s research found that even with insurance, the cost of preventative care is too high for a lot of women. Forty-four percent of the women she interviewed say high deductibles, prescription costs and co-pays all impacted their health care decisions.
“It’s not about them not being willing to make choices. It’s about them not being able to follow through because of a variety of constraints, including really powerful financial ones that get in the way,” she said.
“From a purely financial perspective, these companies are having to guess – am I actually saving myself any money by doing the screening? Or am I just incurring the cost of the screening?”
Athos Health CEO Jon Hess said health insurance companies aren’t to blame for the lack of coverage. They don’t set the standards.
“Most health plans drive it off of the U.S. Preventive Care Task Force, which is supposed to be an independent group of doctors that decide what tasks are medically appropriate for individuals.”
The task force is updating its recommendation, but until it includes more coverage for preventative measures, “I can’t tell you how hard it is to have a conversation with women where their mother died at the age of 35 because of breast cancer, and yet they’re 35 and can’t get a mammogram covered as preventative,” Hess said.
“Some of the choices that they’re asked to make are very problematic and challenging,” Padamsee said.
“That MRI is not covered by insurance can be several thousands of dollars.”
Women will continue to have hard conversations and make costly calls.
Padamsee’s study found that women from all socioeconomic backgrounds worried about the cost of covering preventative care.