U.S. Health Care Insurance: Picking on Women

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.”

 

 

 

 

Womb Transplants

The latest news on the fertility front is that a 25-year-old Swedish woman is going to have her 56-year-old mother’s womb transplanted into her. Apparently the age of the uterus is not a problem as it would be with eggs or ovaries. This procedure has been successful in animals, but not so far in humans. The only human attempt, which failed after four months due to complications, was in Saudi Arabia eleven years ago. However, doctors are optimistic that womb transplants will eventually be a viable solution for the more than 5,000 women each year who lose their wombs due to various diseases, not to mention women who are born without them.

Dr. Giuseppe Del Priore, director of gynecologic oncology at the Indiana University Simon Cancer Center, said the procedure should work because of recent developments. “It’s been my opinion and that of my colleagues both in London and Sweden, we all maintain that it can be safely done at this point,” Del Priore said. Del Priore has spent a decade researching the procedure mainly on behalf of his patients. He also expects that once the procedure is approved, donors will come forward out of their desire to help women birth a child.

At present the only way for a woman without a uterus to have a biological child would be by using a surrogate. Some would argue that even surrogacy is tampering with nature more than God intended us to. But I think womb transplants would be a better solution because they would remove the emotional aspects of surrogacy from the equation. A woman is often bothered by the fact that another woman bore and delivered her child.

Ever since the first “test tube” baby was born in 1978, the treatments for infertility have become more sophisticated and successful. It’s now possible to imagine a future with artificial wombs. Why not? At some point in the future, women may no longer be tied to reproduction. A man could oversee the growth of his child in an artificial womb. All he would need would be an egg donor. Women could pursue their interests and careers without having to undergo pregnancies. (And yes, it would remove the danger of maternal mortality and possibly even lower infant mortality.)

If women aren’t the only way to “grow” a baby, will men feel more invested in their offspring? Will women feel less invested? How would it change the way men and women see their roles in society? Will women continue to be seen as the primary caretakers? Or will men begin to feel just as responsible because they would truly, for the first time, have an equal role in reproduction?

I don’t expect to see a day when babies are grown in artificial wombs, but I do think I will see womb transplants become commonplace. And that’s good news for thousands of women.

Dear 16-Year-Old Me

This is a video that everyone should watch, but it is specifically addressed to teenagers because their behavior puts them at risk for skin cancer either now or later. And few people realize how deadly melanoma can be.

Types of Breast Exams

A week after my recent mammogram I received a letter from my doctor telling me that she had scheduled me for a breast ultrasound. Apparently I have some kind of abnormality that she doesn’t think is cancerous but needs to be looked at more closely. I had a breast cancer “scare” about fifteen years ago which turned out to be nothing, so I’m not particularly worried. But I did think that this might be a good time to brush up on breast disease and abnormalities, diagnostic tests and treatment.

I decided to start with types of breast exams, since this is the first line of defense in detecting and treating breast cancer:

BREAST SELF EXAMINATION (BSE)

One way to find breast cancer in its earliest stage is to complete monthly self-breast exams. Because breast tissue changes at different times of the month, these exams should be done at the same time of the month if you are still having periods. The Susan G. Komen Breast Cancer Foundation recommends that every woman over the age of 20 check for any change in the normal look or feel of her breasts. You should look and feel for a lump, hard knot, skin thickening, or dimples. Any changes should be reported to your doctor or nurse. Ask your doctor for information on completing your routine breast self-exams. You may also contact the Susan G. Komen Breast Cancer Foundation at 1-800-462-9273 for a card to hang in your shower to help you complete your monthly exams.

CLINICAL BREAST EXAMINATION

Every woman should have her breasts examined by a healthcare professional at least every 3 years, starting at the age of 20, and yearly after age 40. A physician can tell a lot about a lump simply by feeling it and the tissue around it. Non-cancerous lumps often may not feel the same as cancerous lumps. They can be harder and may be stuck to surrounding tissues rather than freely movable. Additional tests may be prescribed, including mammography, digital mammography, ultrasonography, or MRI.

If a lump feels like it is a cyst filled with liquid, the doctor may try to remove some fluid with a small needle. This is called aspiration. Based on these exams, the doctor may decide that no further tests are needed and no treatment is necessary. In such cases, the doctor may check you regularly to watch for any change.

MAMMOGRAM

The most common procedure used to diagnose breast cancer is the mammogram, an x-ray of the breast that uses a very low dose of radiation. It can look at the tissues within the breast. A special machine holds the breasts in place with pressure (compression). This simple procedure can reveal cancerous growths that are too small to feel. Although it may feel a bit uncomfortable, it takes only a few minutes to complete. Good compression of the breast is important because it reduces radiation exposure and gives the doctor a better view of abnormalities, which might be hidden behind normal breast tissue. Compression does not harm the breast tissue. If you have breast implants, a special mammography technique pushes back the implant to look at the breast tissue more completely.

The Susan G. Komen Breast Cancer Foundation and the American Cancer Society recommend annual screening mammography for women, starting at age 40, and a baseline exam between 35 and 40.

Special recommendations are made for women who have a strong family history of breast cancer or have been diagnosed with cancer at an age younger than 40. Women with a family history of breast cancer or who have personal concerns about their risk should talk with their doctor about when they should begin having mammography.

Annual screening mammograms in women age 40-49 have been shown to lower a woman’s chance of dying from breast cancer by 17%. For women between the ages of 50-70, a 33-60% reduction in mortality has been reported.

Mammograms are able to find lumps at a smaller size than we are able to feel.

The smallest tumor a mammogram can identify .2 inches to .4 inches
The average size lump found by yearly mammograms when the woman has had previous mammograms to compare the lump to .43 inches
The average lump found by first-time mammograms .59 inches, the size of a dime
The average size lump found by women through their monthly breast self-examination .81 inches (the size of a quarter)

The initial diagnosis of breast cancer may come from the breast self-examination, the physician’s clinical breast exam, or screening mammography. The gold standard continues to be the mammogram. Other tests that help in the diagnosis and staging of breast cancer are listed below.

ULTRASOUND

Ultrasound is also called sonography. This procedure uses sound waves far above the range of normal hearing to view images of the body. No radiation is used in this examination and there are no known health risks. If a suspicious area is identified by mammogram, an ultrasound is often used to explore that area more thoroughly. Ultrasonography can distinguish between a fluid filled cyst and a solid mass (which may or may not be cancer). The American College of Radiology (ACR) suggests that women with dense breasts may benefit from the use of ultrasound.

MAGNET RESONANCE IMAGING (MRI)

Magnet Resonance Imaging (MRI) is one of the most advanced diagnostic imaging tools available in medicine today. Using magnetic fields and radio frequency coils, remarkably detailed cross-sectional images of the body can help your physician diagnose your cancer. MRI does not use x-ray or radiation. Currently, an MRI is used to further assess a suspicious area; it is not used as a routine screening procedure.

The MRI may be more accurate than mammography in the early detection of malignant breast tumors in women with a hereditary risk of developing breast cancer. It might be the preferred test for younger women who have dense breast tissue. Physicians may also order an MRI for women who have a genetic linkage to breast cancer, as they are BRCA1 or BRCA2 positive. It is an appropriate test for women who have breast cancer and need further evaluation. It is also used for women who have implants that need to be checked for possible leakage.

An MRI is more than ten times as expensive as a mammogram. It also has a high false positive rate. This means that it may incorrectly identify breast lesions as being a cancer 20-50% of the time, when in fact the lesion is not cancerous. Thus, the MRI is not yet ready to be used as a screening test for most women.

COMPUTERIZED AXIAL TOMOGRAPHY (CAT SCAN)

The CAT scan uses x-rays and combines the use of a digital computer and a rotating device to make cross section photographic slices of organs and parts of the body. Not used as a screening tool, the CAT Scan is primarily used to evaluate deeper structures in the body for the presence or absence of metastatic disease, or spread of breast cancer to distant sites.

POSITRON EMISSION TOMOGRAPHY (PET SCAN)

This nuclear medicine technique can actually make an image of the internal organs based upon their metabolic activity. Radioisotopes (compounds containing radioactive forms of atoms) are introduced into the body to evaluate organ function or localize disease or tumors. The radioisotope is injected into a vein. In breast cancer, the PET scan is used for staging distant metastases, restaging patients with recurrence, and/or monitoring the response to treatment.

SCINTIMAMMOGRAPHY

Scintimammography is a nuclear medicine test. A small amount of radioactive tracer (dye) is given through the vein. The dye travels to the breast tissue. Scans are taken and the radiologist can differentiate between benign and malignant lesions. This procedure is used in addition to a mammogram and ultrasound. It can assist the surgeon with planning the biopsy.

SOURCE: Medtropolis.com’s Guide to Breast Cancer

Plans for Planned Parenthood

In a news story this morning about the possible government shut-down, it was reported that:

There were hints of Republican flexibility on a ban they were seeking to deny federal funds to Planned Parenthood. Officials said that in talks at the White House that stretched on after midnight on Wednesday, Republicans had suggested giving state officials discretion in deciding how to distribute family planning funds that now go directly from the federal government to organizations such as Planned Parenthood.

That would presumably leave a decision on funding to governors, many of whom oppose abortion, and sever the financial link between the federal government and an organization that Republicans assail as the country’s biggest provider of abortions.

If this is what happens, that would send a very clear message to Americans: Your federal government does not stand behind reproductive health care for women. Instead, it is willing to leave millions of women at the mercy of their state legislatures, some of which have already demonstrated that they are anti-abortion (and not very friendly toward birth control either).

This, in turn, would weaken Roe v. Wade. After all it is the U.S. Supreme Court that ruled on Roe v. Wade. If the federal government gives in on funding for Planned Parenthood, that might influence the Court the abortion issue ever comes before it again.

What are the chances that will happen? It would take a perfect storm of just the right conditions, according to Tony Lauinger, chairman of Oklahomans for Life:

“Ultimately it will require a pro-life president to nominate a pro-life Supreme Court justice who will be confirmed by a pro-life U.S. Senate to provide the fifth pro-life vote on the U.S. Supreme Court to overturn Roe v. Wade,” Lauinger said. “That has been a long-time goal.” Should Roe v. Wade be overturned, Lauinger said the most likely result would be that each state would determine whether abortions would be legal or not. The Supreme Court would return the matter to its status prior to 1973.

For the life of me, I can’t figure out why this nation would want to go back to conditions before 1973.  When I had my abortion in 1971, New York was the only state that had legalized abortion. I was fortunate because I live relatively close to New York. But what about women, who are going to have an abortion anyway, who don’t have the means to travel to a state where abortion is legal. Will they seek out illegal abortion providers and run the risk of being criminalized for doing so? Will we return to the days when women would try to abort themselves, often dying or making themselves sterile in the process?

 

Managing Attention Deficit Disorder at Work and School, Part One

My sister constantly describes herself as “a hamster running on an exercise wheel.” She swears that she has ADD. Whether she does or not, it’s not surprising that she feels that way. Many women, especially married women with children, are prone to feelings of disorganization, lack of focus, difficulty completing tasks, forgetting to pay bills on time, and missing appointments or deadlines.

The difference is that women with ADD do all these things to the degree that they can barely function. This creates real challenges not only at home, but also at work and in school.

A year ago I wrote the post “If You Have, or Think You Have, ADD.” I intended to write a series of posts about women with ADD, but as is typical for someone who has ADD herself, I forgot. However, I figure it’s better late than never (which is something that people with ADD tell themselves, and others, a lot).

The following are common challenges that women with ADD face at work and in school. (Note: These can apply to anyone who feels overwhelmed by their responsibilities, but they’re particularly troublesome for people with ADD.)

  • Finding it difficult to read large amounts of material.
  • Frequently losing things.
  • Forgetting deadlines.
  • Lack of focus when working in an open space.
  • Having trouble following oral instructions.
  • Managing interruptions.
  • Forgetting names and numbers.
  • Tackling boring tasks.
  • Restlessness (in meetings, in class, etc.).
  • Keeping track of paperwork and email.

To successfully combat these common problems, you have to know yourself. What kind of Attention Deficit Disorder do you have, for instance? There are basically two varieties: ADD with Hyperactivity and ADD, Inattentive. The first is the kind most commonly thought of when people think of ADD. It’s typified by physical restlessness and even acting out. The second is a quieter form of ADD, which means that many people with this type of ADD are not even diagnosed as having it. The person with ADD, Inattentive, is prone to daydreaming and not paying attention in class or meetings.

One of the hardest things for all people with ADD is to stay on task, mainly because they get either bored or distracted.

To keep yourself from being bored, break the task down into short segments and intertwine it with other tasks or activities. In other words, take frequent breaks. But not too frequent! Don’t use this advice as an excuse for giving up on a task before you’ve spent a reasonable amount of time on it.

Distraction is probably the most common problem for a person with ADD. That’s why it’s important to make yourself stick to a task for a set amount of time. Obviously in a class or meeting, the time period is pre-determined and usually feels too long no matter what you do. But somehow you have to make yourself pay attention to everything that’s being said. So how do you do that? I’ll cover some suggestions in “Managing ADD at Work and School, Part Two.”

I’m all for tricks and tips to help you concentrate, but I think it’s important to keep whatever you do simple. When a technique is too complicated, a person with ADD often gets lost in the process. There’s no point in using something that requires more concentration than the material you’re trying to master.

Being easily bored or distracted makes it difficult to get organized. Disorganization is the hallmark of a person with ADD. That doesn’t mean that you can’t be organized. But it’s important to find ways to organize yourself that work for you. Not all people are the same, even all people with ADD. For example, some people have to have complete silence in order to concentrate while others like some kind of  “white noise” to drown out other distractions.

For more background on ADD, especially in women, check out an old blog of mine, ADD Women.