More Women Passing On Mammograms
Tuesday Aug 12, 2008More Women Passing On Mammograms in Individual Health Insurance
ORIGINAL POST: 1/24/08
A study conducted by Brown University and Harvard Medical School found when a copayment is required for a mammogram, many women between ages 65 and 69 years old with Medicare coverage do not get the screening for breast cancer.
The study’s results were published in the New England Journal of Medicine.
Women with plans that required copayments for mammograms had an 8 percent lower rate of screening than women with full coverage, reported Medical News Today.
“The message is simple and it’s startling — a small copayment for a mammogram can lead to a sharp decrease in breast cancer screening rates,” said the lead author of the study, Amal Trivedi, M.D.
The study suggested even a $12 charge is a large enough barrier for women to skip mammograms.
“Eliminating copayments for mammograms in the Medicare program has the potential to save lives, because screening detects breast cancers at an earlier, more curable stage,” said Harvard professor and study co-author, John Ayanian, M.D.
But it’s important to make sure you go in for regular mammograms, recommends the National Institute of Cancer. Women over the age of 40 should go in for a mammogram once every 1 to 2 years. Younger women should also regularly do breast self-exams to check for lumps.
Breast cancer claims the lives for around 40,000 women in America, according the Mayo Clinic. And with the right preventive care and screening, women can make sure they catch it early. So, really, it is worth it to spend a few dollars to get screened.
Posted by Darla L Keener on January 31, 2008 at 03:30 PM CST #
The reason?
The charges were over what BCBS considers "reasonable and customary". They were originally planning to deny my claim altogether because they "requested more information" from me-- what, my address which hasn't changed in 17 years-- and I "failed to provide the information in a timely fashion"... that is, I didn't respond BEFORE they mailed the denial and request letter, I guess. That was the first request I knew of!
No wonder BCBS is getting in trouble.
I guess I won't be doing MY mammos in a timely manner any more, either. I can't afford that kind of a bill every year WITH insurance... much less without.
Posted by schrodinger on August 10, 2008 at 06:34 PM CDT #
Insurers set these rates based on what other health care providers are charging for that particular medical service in your area. But there are a couple things to consider when it comes to these Usual, Customary, and Reasonable rates.
(The tips here were provided by members of the Research Team who have worked for major health insurance companies.)
The Blue Cross Blue Shield companies usually have excellent customer service, so always use customer service as your advocate! Most customer service reps are willing to help you navigate the system and give you helpful pointers that can save you a lot of money down the road.
A good service rep will know all the UCR rules and can even help you before you go into the doctor, so don’t be shy about contacting the service rep before going in for a medical service. When you use your service rep as an advocate for you, you’ll be surprised how much bureaucracy you can get around!
Also, make sure you document everything. Follow-up every interaction with insurance companies with an email or letter — and save a copy. Ask the service rep send you written confirmation on what they just told you. All this documentation will help you if any items of dispute arise.
You can ask your insurance company and/or service rep how they decided on the UCR rate, as well. And you do have the right to appeal the UCR rate. But keep in mind that many insurers can get care providers to agree to lower rates with a little nudging.
Here’s an example of a real-life customer service rep in action:
A service provider charged a parent $300 more a day for a newborn baby’s UV “billy blanket” than their insurance company’s UCR rate. In total, the parent would have been responsible for a bill for $2,100. But when the parent called their service rep, the rep started a discussion between the service provider and the insurance company. Once everything was settled, the $2,100 bill was erased!
Posted by The Research Team on August 12, 2008 at 10:12 AM CDT #