Mammogram shows something - now what?
You do have to pay upfront for the mammogram and sonagram. But whenever I've had to do an MRI they (MBC) accept whatever my insurance will pay. I think that was also the case for the biopsy I had there. The attention and speed at Montclair brings a great peace of mind.
krugle said:
Good news. So they don't take insurance? Strange.
Perhaps it's more accurate to say: MBC may count as 'out-of-network' to your insurance provider.
That being said: I have a high-deductible healthcare plan, so in the end, I'm not sure that the costs will end up being that different from Overlook in my case (which was in-network, and their bills for the original mammo and follow-up mammo with U/S are just starting to come in now).
Not all insurance plans have "out of network" coverage. It depends on what the employer or other sponsor specifies. My family gets NO out of network coverage. But our in-network coverage is pretty good and the employer subsidy for the premiums is also significant, so I'm not complaining.
MBC does not take anyone's insurance up front. You have to be able to pay out of pocket. You will have to accept whatever your company will reimburse...if they reimburse for out of network.
Dianaid -- A belated thank you for comparing notes on Anthem. Nice of you to take the time, and I listen extra hard to your comments, because you have lived through some stuff. Thanks also, Sprout. I would definitely go to Montclair Breast Center if cost were not a factor. The Anthem site indicates that there is a cheap place in Westfield, and I'm calling them tomorrow. Wish me luck.
gerryl said:
You do have to pay upfront for the mammogram and sonagram. But whenever I've had to do an MRI they (MBC) accept whatever my insurance will pay. I think that was also the case for the biopsy I had there. The attention and speed at Montclair brings a great peace of mind.
How much do the mammo and sonogram cost? Sounds like it would be expensive. I never heard of a radiology practice that is not a participating provider for any insurance company.
It is expensive. Just went there today. The mammo and sonagram were $915. It is definitely a boutique shop. But my sister and mother have each had cancer. My mother twice. I live with a lot of stress with a grown child with autism. So, for me it gives me a sense that I will learn early and quickly if I do develop cancer.
@gerryl : I assume your mammo at MBC was 3D?
FWIW: I just got my bill from Overlook (Simons Breast Center):
Initial 2D Mammo:
- Unadjusted: $842
- Adjusted to negotiated rate: $459
- Insurance paid: -$383 (I assume this is coverage for typical preventive care)
- My portion of the bill: $153
So, all looks reasonable, until the follow-up 2D mammo and ultrasound:
- Unadjusted: $1,412
- My portion of the bill: Adjusted to negotiated rate (and it appears there is no insurance coverage for this follow-up): $726
So that brings my total for regular annual, plus follow-up imaging (although the bill says "Imagining Ultrasound") to:
$879
Note: I am 'in network' at Overlook, but on a high deductible plan. So it appears that I pay the negotiated rate until I hit the deductible, with the exception of some covered preventive care.
ETA: I just got another bill from "Summit Radiological Assoc/ dba Westfield Imaging Center".
- Unadjusted: $450
- Adjusted to negotiated rate: $101
- It appears insurance paid: $0
- My portion of the bill: $101
So, add another $101 out of pocket for the follow-up Mammo & U/S imaging at Overlook (I'm guessing this is the charge for the technician? It's unclear what is different from the $726 charge).
In conclusion, my total out-of-pocket bill from Overlook (for which I am "in Network") for initial 2D Mammo, then follow-up 2D Mammo and Ultrasound is now:
$980
Yes, MBC is 3D. They are also encouraging me to do a panel of genetic testing because there are now more genes that can be correlated with breast (and ovarian and colon) cancer. And to take a medication that is supposed to be helpful in preventing or lowering the odds. I am going to review these over time. My insurance will not cover the testing, and the drug has some bad side effects.
My doctor also wanted me to take tests, etc., He wanted me to take the genetic test. It was quite expensive, luckily my insurance paid for it. There was alternative testing company which he felt would suffice not as good but much, much cheaper if I was not covered by insurance.
gerryl said:
Yes, MBC is 3D. They are also encouraging me to do a panel of genetic testing because there are now more genes that can be correlated with breast (and ovarian and colon) cancer. And to take a medication that is supposed to be helpful in preventing or lowering the odds. I am going to review these over time. My insurance will not cover the testing, and the drug has some bad side effects.
I am surprised your insurance won't cover the genetic test. The standard is that they will pay for BRCA testing if a first-degree relative has had breast or ovarian cancer.
I just got another bill from "Summit Radiological Assoc/ dba Westfield Imaging Center". So, add another $101 out of pocket for the follow-up Mammo & U/S imaging at Overlook. I edited my total costs in my post above.
Sprout, thank you for laying it out. In this era of "insured" patients having to contend with both very high premium costs and very high out of pocket costs for prescribed screens done by in-network providers at in-network facilities, I think noncompliance will become more of an issue. People will skip the screens. We are going to start to see "insured" women being diagnosed late.
Shoshannah- the genetic testing they are recommending is for more than the BRCA genes. They told me the panel covers around 25 genes that indicate cancers including ovarian and colon. My mother was tested and hers was not positive for BRCA. My sister did not get tested because she couldn't afford it at the time.
breal said:
Sprout, thank you for laying it out. In this era of "insured" patients having to contend with both very high premium costs and very high out of pocket costs for prescribed screens done by in-network providers at in-network facilities, I think noncompliance will become more of an issue. People will skip the screens. We are going to start to see "insured" women being diagnosed late.
Agreed. And health care coverage is not straightforward. I'm fortunate that we are able to contribute to our pre-tax heath savings account, and it carries over across years (it's not use-or-lose, like the Flex spending accounts that go with higher coverage plans). Initially high deductible plans included employer contributions to the health savings accounts -- but unfortunately that seems to be falling out of fashion.
What I find interesting is that for my own high-deductible insurance case, the cost of 'in network' Overlook, and out-of-network Montclair Breast Center, may not end up being very different in terms of my out-of-pocket costs. As someone with dense breast tissue, it's likely I'll need the mammo and ultrasound follow-up annually (and maybe even the occasional MRI). So, I'll need to anticipate these costs when I enroll in healthcare each year. And since MBC does 3D mammograms (which seem to provide better imaging for dense tissue), and I felt more comfortable there after my recent consultation, I'll continue to go there.
I'm guessing that for plans providing greater amounts of coverage (i.e., not high-deductible plans), 'in network' breast centers could be substantially less expensive. But part of the cost issue seems to be that follow-ups (including mammos, ultrasounds, MRIs and biopsies) may not get as much coverage.
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My original biopsy was going to be Ultrasound guided.
Conclusion: I went for a second opinion at the Montclair Breast Center on a friend's recommendation. They do not really take insurance -- but they do fill out forms for you to submit yourself. I had a "film review", and got to have a discussion with the radiologist while she pointed out what she was seeing in each of the images. (At Overlook, the radiologist did not show me any images, and did not really tell me much other than that he wanted to do a biopsy).
The second-opinion radiologist at MBC also recommended a biopsy based on the images from my Overlook appt, which had been taken 3 weeks earlier. I indicated that I had experienced a substantial impact to the chest (while playing sports) shortly before the U/S images were taken. So, she sent me into their ultrasound room where the tech did a new U/S -- and neither the tech nor this radiologist could find a problem area anymore (a month had now passed since the impact). There was nothing to biopsy.
@breal : I sympathize. I'm pretty sure if I had just gone back to Overlook, I would have been prepped for the biopsy, with Mr. Frustrated Radiologist getting annoyed when preparing to do the procedure that he couldn't find the thing on the U/S to do the biopsy on.
Note: I paid a few hundred out of pocket for this second opinion with an Ultrasound. I'm happy to have found a radiologist I feel more comfortable with, at a place that has 3D imaging, and an MRI machine in the building. Montclair Breast Center will be my go-to place for future check-ups. But it's unfortunate that the cost for this can be prohibitive.