Denied Insurance-what to do

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I had breast cancer (DCIS) 2 years ago.  I will be up for my yearly mammogram at the end of Dec.  I moved from AZ to TX in June and went to transfer my health insurance over.  I was denied and I know there are options-high risk pool but that is going to be outrageously expensive for the budget and not doable.  I don't mind paying out of pocket for a mammogram but when I went to make the appointment I was told a doctor would need to order a diagnostic mammogram.  How can I get a mammogram without having a doctor first?  btw-I am 38 yrs old. 

Comments

  • Bren-2007
    Bren-2007 Member Posts: 6,241
    edited October 2010

    Hi Steph,

    Try contacting your local health department and ask about the Breast and Cervical Cancer screening program.

    I am self-employed and had no insurance.  This program saved my life.

    Best of luck to you,

    Bren

  • StephH
    StephH Member Posts: 9
    edited October 2010

    I just pulled up the website.  Here are the eligibility requirements:  uninsured or underinsured women at or below 250% of federal poverty level, ages 18-64 for cervical screening, ages 40-64 breast screening.  As I said, I am 38 & in need of a diagnostic mammogram.  I am not filthy rich nor do I live on the street in a box, sometimes I feel that is the only way to get things in this country.  I should also note I have called lots of hotlines, 1800-4-CANCER, the cdc, CANCER CARE, Patient Advocate, Dept Health, and hospitals.  They can all refer me of where to go for a mammogram, but once I make the appt. I am asked for a dr's name. 

  • Medigal
    Medigal Member Posts: 1,412
    edited October 2010

    I thought these new state High Risk programs were supposed to accept you even if you have a pre-existing disease.  The main problem is you have to stay off insurance for 6 months to be able to sign up.  That means 6 months paying for everything yourself.  If you are living now in Texas, why don't you go to your state's site concerning this new government program each state is supposed to have and it will tell you exactly how much your premiums will be.  It should not be exhorbitant for one person.  That is what the Healthcare Bill was to be able.  Helping people in your predicament get affordable insurance when they can't get it privately.  I hope you work this out.  Do you not have even a primary care doctor who could write out a mammogram RX for you?  It doesn't have to come from an Oncologist.  What about these Urgent Care Centers we have now all over the place.  There should be someplace you can get a mammogram without it bankrupting you.  B est of luck!

  • lovemygarden
    lovemygarden Member Posts: 342
    edited October 2010

    Oh for the good old days 20 years ago when we could get a blood test, pregnancy test, mammogram, etc by simply going to a lab and paying for it. *sigh* Now we have to jump through hoops and practically sit up and beg for every little thing. Yell

    Steph, look in the Yellow Pages and start calling local radiologists offices, to ask if they have any upcoming free/public mammogram programs. One of the big radiology firms (they have 3 or 4 different locations) in my area does this once every 3 months at one of the local hospitals. They offer free walk-in mammograms and also drastically cut-rate (as in $100!) contrast MRIs during these events. What I don't know is whether you still need a doctor's Rx or whether you can just walk in, wait in line, and get one done. If you're lucky they may only require a doctor's name and address to send the results to. 

  • Annabella58
    Annabella58 Member Posts: 2,466
    edited October 2010

    Steph, go to a local women's free clinic.  Get an OB/GYN free exam.  Ask the dr. there about options.  She should be able to write you a script for a mammo.  Also, if that doesn't work, there should be, as above, free mammograms buses that do come around.  They make it to most states, just google "free mammogram buses" and see what comes up.

    Good luck!  I had no insurance at all when I had my first bc in 2001.  If they tell you you must pay out of pocket for it, call the local hospitals' billing dept.  Ask for a "hardship" payment plan.  They by law, must comply and work with you.  This will not be offered unless you ask for it.

     My 80 year old mom just went for her first ever.  She did not have a primary dr. at all, nor a script.  She used that mammogram bus clinic.  They generally park at libraries, or grocery plazas.  The site should have an 800 # you can use to call them.

  • lovemygarden
    lovemygarden Member Posts: 342
    edited October 2010

    Unfortunately most "hardship" rates require you to have an income that is laughably low, plus assets that are practically nonexistent. As the OP pointed out most accurately, there is very little help for patients who are in the middle class and trying to stave off being hardship cases.

    Here is the catch-22. If you have a test done at a hospital, the "full ticket price" is almost always HIGHER than if you have the same test done at a radiology office. So even if the hospital extends you a 20% discount (which is the usual maximum non-hardship courtesy they will give an uninsured person) the cost of the test may be higher. It's like a store that marks up all their prices and then puts up "big sale" signs.

    I have to get a MUGA scan every 3 months because I'm on Herceptin. No insurance. So I shopped around. These are were the rates I got for the exact same test:

    Hospitals (I shopped 5, this was the least expensive quote):

    MUGA price $850. Less 20% courtesy self-pay discount of $170 = $680. Mandatory NY State surcharge for all services performed at a hospital or billed by a hospital: 9.3%. $680 x 9.3% = $63. Total cost to have my MUGAs done at a hospital: $743.

    Radiologist's office: MUGA sticker price $750. Courtesy price for self-pay, pay in full at the time of service: 1/3 off. NY State surcharge does not apply to services done in a non-hospital setting. Total cost to get my MUGAs at the radiologist's office: $500.

    We who are uninsured have to constantly ferret out the best prices possible for everything.

  • lago
    lago Member Posts: 17,186
    edited August 2013

    Have you contacted the local American Cancer Society? They are really good at helping with things like this.

    http://www.cancer.org/ 

    http://www.cancer.org/Treatment/FindingandPayingforTreatment/ManagingInsuranceIssues/HealthInsuranceandFinancialAssistancefortheCancerPatient/index 

    BTW I think the ACS also  has aid for free mammograms. I don't know about the eligibility though.

  • stlrepke
    stlrepke Member Posts: 34
    edited October 2010

    Is there an issue because it's a Diagnostic and not a Screening Mammogram? Like one of the other ladies mentioned maybe visit or call the free clinic and see if they can write the script for the Diagnostic. Good luck!

  • StephH
    StephH Member Posts: 9
    edited October 2010

    YES stlstroller THAT IS THE PROBLEM!!!  The mobile units for free mammos are fine, but I NEED DIAGNOSTIC!!!  You got it!

    I found I can get the mammo for $84.00 (fine, no prob) but then they ask for a dr to send the results to or a dr to order the DIAGNOSTIC mammo.  I'm thinking my best bet would be to try the women's clinic for an exam & get that dr to write one.  Maybe that would work, not sure until I try.  Other option is to go uninsured for 6 months then I would be eligible for the pre-existing condition health insurance that is supposedly affordable but not so much.  I would have to wait until April 1 to do this. 

    Thanks for all your help.

  • AnneW
    AnneW Member Posts: 4,050
    edited October 2010

    Try getting an appointment at the GYN's with a nurse practitioner. Their fees are usually quite a bit lower. She can write for the diagnostic mammogram.

    The next question, though, is if you don't have health insurance, what will you do in case that diagnostic mammo leaves you with a less than desireable result? This is the scary part about not having insurance.

    Best of luck to you,

    Anne

  • lovemygarden
    lovemygarden Member Posts: 342
    edited October 2010

    This question is probably going to sound really stupid but..... What is the difference between a "screening" and a "diagnostic" mammogram?  Aren't they both the same procedure?

    The two times that anything weird ever showed up on a mammogram, the next step was to do an ultrasound (not a second mammogram). So I have always just assumed that the normal procedure was mammogram -> ultrasound -> contrast MRI -> surgery if needed. Never knew there were different 'types' of mammograms; what is the difference?

  • StephH
    StephH Member Posts: 9
    edited October 2010

    lovemygarden That's not a stupid question at all.  I didn't even know there was a difference as I thought it would be easy to get a mammogram without insurance.  Not until I figured out it's not so easy if you have had breast cancer before.  Silly me *sarcasm*

    The regular mammos just show front to back, side to side.  Because I am a survivor I'll be needing a more detailed version, showing exact location, size of the area where the cancer was before. 

    AnneW-scary thought indeed.  One I'd rather not think about.  I'll just take it one step at a time.

  • lovemygarden
    lovemygarden Member Posts: 342
    edited October 2010

    Steph, thanks for the explanation -- I learned something!

    Because I had a BMX with no reconstruction, I won't be needing mammograms anymore; the routine now will be monthly self-exam -> regular exams by breast surgeon -> ultrasound if anything feels suspicious. 

  • lwd
    lwd Member Posts: 1,084
    edited October 2010

    I should know the answer to this, but, sorry, I don't.  I know that after my first bout with BC 13 years ago I had diagnostic mammos every year.  Now that I have mets, my onc only orders yearly digital screenings.  I'm thinking the diagnostic mammos are more extensive?  Now that I have mets and other regular scans such as PET/CT, maybe he thinks the diagnostic mammos aren't necessary?  Hopefully, someone with more knowledge can weigh in here?  Guess I should ask him.

    Lane 

  • lwd
    lwd Member Posts: 1,084
    edited October 2010

    Whoops, didn't read previous post carefully enough before replying.  Guess before mets they were more concerned with a recurrence in my breast.  Now, it has spread to other areas (with no new tumors in my breast), other more expensive scans should show what's happening.  I do remember the diagnostic mammos were more expensive!

    Lane

  • StephH
    StephH Member Posts: 9
    edited October 2010

    So today I made an appointment at a clinic with a gynocologist for a new patient visit.  It was very easy to do and they even offer a 40% discount for paying out of pocket.  (It's still going to be  $200, eek).  From there, the dr will order the diagnostic.  Problem solved.  Except for paying for all of this, of course.  LWD, the diagnostic mammos are more expensive you say?  UGGGG 

  • rreynolds1
    rreynolds1 Member Posts: 450
    edited October 2010

    Unless they ask for payment when they do the diagnositic mammo, you may be able to make payment arrangements after the fact.  I have a high deductable plan (5,000 before anything except wellness is covered) so I made payment arrangements for many of my diagnostic and treatments.  It was no big deal and the payments were reasonable.

    Roseann

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