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Hidden Breast Cancer Scans Cost Patients Thousands
28 Aug
Summary
- Preventive breast MRIs can result in unexpected patient bills totaling over $1,191.
- Federal guidelines, not state laws, often determine MRI coverage for certain plans.
- Advocacy groups suggest patient navigators to help lower screening costs.
Stephanie Halver, 43, received a high breast cancer risk assessment, prompting her doctor to recommend an annual breast MRI alongside her mammogram. Although preapproved by her insurer, Halver was billed $1,191.10 for the scan, plus additional charges for medication. This unexpected cost arose because, while mammograms are universally covered preventive care under the Affordable Care Act, preventive breast MRIs are not explicitly categorized as such by the U.S. Preventive Services Task Force for all individuals.
Federal guidelines differ for patients with abnormal mammograms, where additional imaging like MRIs is considered preventive. However, for those with dense breast tissue and a negative mammogram, the task force finds insufficient evidence to mandate no-cost coverage. State laws requiring coverage often do not apply to self-insured, employer-sponsored plans, leaving individuals like Halver responsible for costs applied to their annual deductible.
To manage potential future expenses, experts advise seeking patient navigators, utilizing community resources, and shopping around for imaging centers that may offer lower prices. Scheduling MRIs at the end of a deductible year can also help minimize out-of-pocket costs for these crucial screenings.
