Dense breast patients at higher risk of cancer may need more screening. Who pays for it?
Every year, more than 300,000 women are diagnosed with breast cancer. Last year, Rochelle Broder-Singer was one of them. She says her cancer wouldn’t have been caught had she not done an ultrasound, too, but many women face challenges getting insurance to cover them. “I got the call from my doctor who told me that I had breast cancer, and I actually had to ask her to repeat herself,” Broder-Singer told NBC6. Broder-Singer was 49 years old when she was diagnosed with a common form of breast cancer last year. She says she caught it early thanks to diligent screenings, but as a woman with dense breast tissue, it wasn’t just a mammogram she needed. “I just had a mammogram, and the technician turned to me right then, and she said, ‘You have very dense breasts. You’re also going to need an ultrasound. You’re always going to need an ultrasound,'” she said. Women are now being told of their breast density after a new rule from the FDA. Dense tissue is a risk factor and can make it difficult to spot cancer on a mammogram. “Now that women are being informed about their breast density and told that they have dense breasts, I hope it leads to them asking the question, what does this mean? What can I do about it?” Broder-Singer said. Many women are asking, who’s going to pay for it? Back in May, NBC6 checked with a number of the top health insurance companies and got a mixed bag about whether a breast ultrasound is covered. Fast forward to the FDA’s new recommendation, and we checked in again. Some health insurance companies didn’t respond; however, Aetna, Florida Blue, and United Healthcare told us ultrasounds can be covered if a doctor deems it medically necessary. What is deemed medically necessary is left up to interpretation though. “I think with that recommendation now in writing, I think things from the insurance coverage will change,” said Dr. Carmen Calfa, a breast oncologist with the University of Miami Health System. “I’m confident that they will, because they see the reasons for why, and they will honor, and they will follow the science an ultrasound would double the detection rate of.” She is optimistic about the FDA recommendation. As for right now, women under 40 or those requesting further imaging as a precaution are having to pay for it. “I will tell you that many years, I actually paid for the ultrasound out of pocket instead of putting it through my insurance because it was less expensive to pay cash as a cash-paying patient than the copay or deductible that I would have had to pay if it went through my insurance,” Broder-Singer said. She said the ultrasound caught her cancer early, and she’s learned a lot of lessons with cancer, such as the importance of getting a second opinion, keeping a running list of questions for doctors and that knowledge is power. NBC6 spoke to several diagnostic centers, which said that if an ultrasound is covered for a medical reason, you could still be on the hook for the deductible and co-pay. If you decide to pay out of pocket, make sure to ask the cost which could run anywhere from $150 to $400. At times, the out-of-pocket cost could be less than their deductible.
Every year, more than 300,000 women are diagnosed with breast cancer. Last year, Rochelle Broder-Singer was one of them.
She says her cancer wouldn’t have been caught had she not done an ultrasound, too, but many women face challenges getting insurance to cover them.
“I got the call from my doctor who told me that I had breast cancer, and I actually had to ask her to repeat herself,” Broder-Singer told NBC6.
Broder-Singer was 49 years old when she was diagnosed with a common form of breast cancer last year. She says she caught it early thanks to diligent screenings, but as a woman with dense breast tissue, it wasn’t just a mammogram she needed.
“I just had a mammogram, and the technician turned to me right then, and she said, ‘You have very dense breasts. You’re also going to need an ultrasound. You’re always going to need an ultrasound,'” she said.
Women are now being told of their breast density after a new rule from the FDA. Dense tissue is a risk factor and can make it difficult to spot cancer on a mammogram.
“Now that women are being informed about their breast density and told that they have dense breasts, I hope it leads to them asking the question, what does this mean? What can I do about it?” Broder-Singer said.
Many women are asking, who’s going to pay for it?
Back in May, NBC6 checked with a number of the top health insurance companies and got a mixed bag about whether a breast ultrasound is covered.
Fast forward to the FDA’s new recommendation, and we checked in again. Some health insurance companies didn’t respond; however, Aetna, Florida Blue, and United Healthcare told us ultrasounds can be covered if a doctor deems it medically necessary. What is deemed medically necessary is left up to interpretation though.
“I think with that recommendation now in writing, I think things from the insurance coverage will change,” said Dr. Carmen Calfa, a breast oncologist with the University of Miami Health System. “I’m confident that they will, because they see the reasons for why, and they will honor, and they will follow the science an ultrasound would double the detection rate of.”
She is optimistic about the FDA recommendation.
As for right now, women under 40 or those requesting further imaging as a precaution are having to pay for it.
“I will tell you that many years, I actually paid for the ultrasound out of pocket instead of putting it through my insurance because it was less expensive to pay cash as a cash-paying patient than the copay or deductible that I would have had to pay if it went through my insurance,” Broder-Singer said.
She said the ultrasound caught her cancer early, and she’s learned a lot of lessons with cancer, such as the importance of getting a second opinion, keeping a running list of questions for doctors and that knowledge is power.
NBC6 spoke to several diagnostic centers, which said that if an ultrasound is covered for a medical reason, you could still be on the hook for the deductible and co-pay. If you decide to pay out of pocket, make sure to ask the cost which could run anywhere from $150 to $400. At times, the out-of-pocket cost could be less than their deductible.
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