KNOXVILLE, Tenn. (WATE) – A cancer survivor is questioning why she was billed for a breast screening procedure. Unable to have a mammogram, Donna Ferguson was ordered to have an ultrasound test, but she says she was still charged for the exam. She believes that was wrong.
Breast cancer is the most commonly diagnosed malignancy in women worldwide. Mammograms are used to check for breast cancer. Many health plans, including ones under the Affordable Care Act, or Obamacare, pay for annual mammograms starting at age 40, with no deductibles or co-insurance.
Sometimes mammograms are used for women treated for breast cancer in the past and have had reconstructive surgery. Because she had a double, radical mastectomy, Donna Ferguson was unable to have a mammogram, so her doctor suggested another type of test.
“He told me at first you should go have a mammogram. I said, ‘I can’t have that. Remember, I had a mastectomy.’ He said, ‘That’s right, You have to go for an ultrasound,'” said Donna Ferguson.
Breast ultrasound uses sound waves to make images of the breast. It is often used as a follow-up to a mammogram screening test for women with dense breast tissue. Donna Ferguson wonders why was she charged for the procedure
“I realized that my mammograms in the past had always been free. Why wasn’t the ultrasound free? I’m doing the same preventative medicine that I was doing all along, just that I’m not able to have a mammogram because of the mastectomy,” she said.
Ferguson and her husband are retired. Since she is not old enough for Medicare, she’s insured under the Affordable Care Act, or Obamacare. She followed up with her insurance provider to see if they would cover the ultrasound as a preventative screening test.
“So, I jumped through all the hoops. I did everything they said, I called them up, they reapplied it, it will take a couple of months follow up,” she said.
The answer came a few weeks ago in the form of a call from her radiologist saying they would not cover the ultrasound. It was considered a diagnostic test instead of a screening test, a decision Donna Ferguson disagrees with.
“Yes because I am doing my due diligence to save the insurance company money by keeping healthy so they don’t have to pay for additional chemotherapy for me,” she said.
The bill for her ultrasound procedure was $150, plus a $25 deductible which she and her husband can afford.
“Oh, no, it’s definitely not the money. It’s the aggravation and for other people who might be in a lot more dire straits than we are,” she said.
“And its the principle of the thing. There are so many people in her situation, probably on Obamacare,” said Dennis Ferguson.
Under the Affordable Care Act and most insurance plans, the cost of a mammogram is covered 100 percent as a screening procedure. However, insurance coverage for ultrasound is not part of screening recommendations by either the National Comprehensive Cancer Network or the American Cancer Society.
“I believe that preventative service like an ultrasound for prior breast cancer patients should be covered the same way a mammogram would be. It would just make total sense. Unfortunately, the health care system doesn’t make total sense any longer,” said Donna Ferguson.
Under Medicare, the government plan pays for a diagnostic breast ultrasound if medically indicated. However, if breast ultrasound is performed as a screening study, a Medicare patient would be responsible for payment.
Donna Ferguson said she was doing her due diligence by having the ultrasound test to keep healthy, saving her insurance company money so they wouldn’t have to pay for expensive chemotherapy later on.