I know my last few posts have focused quite a bit on either me or the kids. But this time, I’m actually going to turn my attention to my wife, Samantha (Sam). Now that we’re both in our mid 40s, there are certain health precautions that are becoming more relevant. For her, that’s a mammogram. For me, it’s a colonoscopy. I’m hoping to push mine off for another few years. We’ll see.
But Sam went in for her first mammogram about a year ago and I wanted to share a little about her experience and what we learned about paying for different types of mammogram screenings.
Not all mammograms are created equal
According to the American Cancer Society, the recommended age for a woman’s first mammogram is between 40 and 44. When Sam went in she had a usual screening mammogram. The doctor said the results came back with a few usual spots and advised us to follow up with an another mammogram.
The first mammogram was free. The follow-up wasn’t.
Confused? So were we.
Mammogram pricing breakdown
Most of us think that mammograms are free. And we would be correct (at least in part).
Screening mammograms are free through almost every insurance plan. From ACA marketplace insurance, to private and group health insurance. And by “free” I mean you don’t have to pay even if you haven’t met your deductible or if you have a cost-sharing program that typically involves a co-pay or co-insurance.
Here’s the clincher: Diagnostic versus screening.
Diagnostic versus screening
A diagnostic mammogram (which is what the doctor told Sam to get for her follow up) is not covered under the same rules. So it is subject to the typical insurance plan red tape. If you haven’t met your deductible, you will have to pay a portion of the cost-sharing based on your plan.
An article from The Chicago Tribune describes it this way: “Screening mammograms are X-rays of breast tissue recommended for women to have annually beginning in their 40s. Diagnostic mammograms use X-ray imaging to show different angles and are ordered if a doctor notices abnormalities on a routine scan.”
The Kaiser Family Foundation offers a great breakdown of coverage of various services that I encourage you to look at. Another resource on what to expect for pricing is the preventative care benefits for women page on Healthcare.gov.
Sam ended up having to pay a $65 co-pay for her follow-up mammogram, which was a diagnostic mammogram. Thankfully, she was able to pay through our Health Savings Account (HSA) with her benefits card. If needed, our pre-tax health account would cover additional diagnostic tests, as well as hospital services, lab fees, and mastectomy-related special bras.
What to do next
As a patient, Sam felt like she should have been better informed of the price differences before the treatment was administered. Price transparency continues to be an issue in healthcare, but recent legislation has been aimed at repairing that.
In situations like this and other healthcare decisions, we hope price transparency will continue to be a priority. In the mean time, it is a comfort to know that our HSA is there to cover any unexpected out-of-pocket costs.
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