Insurance Coverage for Breast Cancer: Mammography Exams, etc.

October is Breast Cancer Awareness Month, which is an annual campaign run by a collection of organizations, such as the American Cancer Society (ACS), the National Cancer Institute (NCI), and Susan G. Komen for the Cure. A mammography is an examination of the human breast used to diagnose cancer. Having a regularly scheduled mammography is the best way to protect yourself against breast cancer; regular mammography appointments give your doctors the opportunity to catch any abnormalities as early as possible. As of 2013, The ACS estimates that there will be about 232,340 new cases of invasive breast cancer diagnosed in women, and about 39,620 women will die from breast cancer. Breast cancer is the second leading cause of death in women, only surpassed by lung cancer. It’s estimated that about 1 in 36 women will die of breast cancer.

Cancer is something that everyone wishes they could avoid, but unfortunately something that many of us have experience with, either ourselves directly or through someone we love. Being diagnosed with cancer is incredibly overwhelming, and there are so many things to consider through the process that the cost of treatment is likely the farthest thing from anyone’s thoughts. However, it’s important to be informed about what your coverage includes and doesn’t include so that you know the best way to move forward with your treatment post-diagnosis.

Reading your insurance plan is the first step in understanding your coverage. Remember that no insurance plan will cover all of the costs of cancer treatment, but the amount of coverage varies by provider and plan. Most hospitals and treatment centers have financial counselors who can provide you with assistance with your insurance paperwork and estimating your treatment costs. Although they may not be able to help with your insurance plan specifically, their experience with patients like you will be reassuring while you go through this difficult process. In addition to the literature provided by your insurance company, this list of questions can aide you in discussing your options with both your provider and your doctor:

  • How does my coverage differ between receiving treatment from doctors who are considered “in-network” versus those that are “out-of-network”?
  • Which costs are covered specifically by my plan, including doctor’s visits, blood tests, exams (radiography, mammography, etc.), surgical procedures, chemotherapy treatments, etc., and will I be responsible for any co-payments or deductibles?
  • Will I be expected to pay for my treatments and then receive reimbursement, or will my bills be paid by the insurance provider directly? What is the full process for treatment payment?
  • Is there a cap for my prescription drug coverage? Considering the prescriptions I’m already on, is it likely that I will reach that cap, and what happens when I do? What will my co-payment be for prescription medication?
  • Which costs are covered/not covered when I need to spend the night at the hospital for treatment?
  • After my diagnosis, does my insurance plan cover getting a second/third opinion? If so, are second/third opinions by specialists outside of my insurance network covered? How do I make arrangements to get a second opinion?
  • Are alternative therapies such as acupuncture covered by my insurance plan?
  • Which costs are covered by my insurance plan if I join a clinical drug trial?

Early detection has been proven to be highly effective in saving lives that are at risk from breast cancer. According to the NCI, when breast cancer is detected early, in the localized stage, the 5-year survival rate is 98%.” You and your loved ones should consider creating your own early detection plan and a regular mammography schedule this October to keep yourselves as healthy and informed as possible! If you’re interested in joining a breast cancer awareness fundraiser, there are many that are looking for participants here!

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