The United States would have the best health care system in the world if it weren’t for its insurers. I’ve had health insurance for forty years and I’ve never seen such a mess as we’re experiencing right now. A recent event in my own life brought this home to me:
I had a routine mammogram this spring and was surprised—and dismayed—when I received a letter saying that I needed a follow-up breast ultrasound because of some suspicious findings. I had to wait over a month for my appointment. I stayed calm and told myself that it probably wasn’t anything. And I was right. There was nothing there. I just have very dense breasts and it was hard to see just what was going on in the initial mammogram. After taking more extensive x-rays it was decided that an ultrasound wasn’t even necessary.
Good thing, because I would have had to pay out of pocket for that, too.
It seems that my insurance company is refusing to pay for the second mammogram because they only authorize one a year. So I’m going to have to foot the $200 bill.
Tell me, please, what I should have done? My doctor ordered the follow-up mammogram to make sure that I wasn’t developing breast cancer. I didn’t ask for the second mammogram. If I’d known my insurance wouldn’t pay for it, would I have had it done? Maybe not.
I don’t have the $200 but I may be able to work out a payment plan. I can pay it off over time. But what about people who can’t even afford to do that? All this policy is going to do is prevent people from undergoing health procedures that just might save their lives.
If I’d had breast cancer, would my insurance company have paid for additional mammograms as I underwent treatment? Or would they charge me for each of them on the grounds that they only pay for one a year?
I recently read that physicians’ associations are now recommending that annual mammograms should begin at the age of 40. Right now most insurance companies are going by the older guidelines which say that mammograms are not “cost-effective” if a woman is under 50. That’s right. Apparently, they don’t think that enough breast cancer is detected between the ages of 40 and 50 to justify the cost of administering the ten mammograms during that decade.
This is despite the fact that breast cancer is usually much more aggressive in younger women. I myself know three women in their 30s who died of breast cancer.
I guess I’m lucky that I’m old enough to qualify for one mammogram a year. But what if I was younger and had a family history of breast cancer? What if it was determined that I had the markers for it? Would my insurance company still refuse to pay for mammograms that my doctor would most likely order?
Another area in which women are being short-changed by the health insurance system is reproductive care. Contraception has gotten much more expensive, but it’s more expensive still to get pregnant and have a baby. So why aren’t insurers attempting to keep the costs of contraception down? Many years ago, I used to get my birth control pills for free or only a small co-pay. Now they can cost the insured $40 or $50 a month. It would be hard for me to come up with that much money each month for contraception. But what choice would I have?
Some insurance companies are batting around the idea that women should have to pay for additional coverage for possible pregnancies and abortions. That’s like making men pay extra because of the possibility that they might become impotent. And I thought that health insurers were no longer supposed to deny people health care coverage because of pre-existing conditions. Isn’t being a man or a woman a pre-existing condition?
I plan to dispute my insurance company’s decision about my mammogram but the chances of winning are probably not good. I have to try, though. We all have to try. We need to stick up for ourselves when it comes to health care for ourselves. We need to protest unfair and discriminatory denials. And we need to keep ourselves informed about what’s going on in the world of health insurance.
UPDATE: It seems that my insurer is not refusing to pay for the mammogram, they just applied it to my deductible. They would have paid for it if it had been considered “preventative.” But an additional diagnostic mammogram is not considered preventative. Bottom line is: I still have to pay for it myself.
I asked what would have happened if I did have breast cancer. I was told that once my deductible is used up, the insurance would pay for treatment at 85% until I hit the $5000 deductible for catastrophic illnesses. I told the representative that I found this very confusing. Her answer? “Yes, it certainly is.”