Health

Preventive care may be free, but follow-up diagnostic tests can bring big bills

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When Cynthia Johnson realized she was going to borrow $ 200 from her pocket for a mammogram test in Houston, she almost stopped doing the test that told her she had breast cancer.

“I thought, ‘I really don’t have that much to spend, and it certainly is nothing,'” said Johnson, who works at an academic evaluation at a university. But she decided to continue the test because she could put a copy of the money on a credit card.

Johnson was 39 years old in 2018 when a mammogram confirmed that the lump she had seen on her left breast was her own. Today, after lumpectomy, chemotherapy, and radiation, there is no cure.

Finding a choice between paying rent and getting the test they need can be a big problem for some patients. Under the Affordable Care Act, many preventive services — like breastfeeding and look at colorectal cancer– they are covered at no cost. This means that patients do not have to pay a regular fee, cash, or the cost of withdrawing their required plan. But if yes showing returns negative results and yes health The caregiver offered additional tests to find out what was wrong, patients could be on the hook for hundreds or even thousands of dollars for research projects.

Most patient counselors as well professional doctors say that coverage should not be extended beyond the initial preventive test to imaging, biopsies, or other critical functions to diagnose the problem.

“The difference between accounting and evaluation is technical,” said Dr. A. Mark Fendrick, director of the University of Michigan Valuation Insurance System. “The federal government It should make it clear that Medicare business plans should meet all the necessary steps to diagnose cancer or any other problem, not just the initial test. “

A study that examined more than 6 million commercial insurance claims to assess mammograms from 2010 to 2017 found that 16% needed additional imaging or other procedures. Half of the women who received additional imaging and biopsy paid $ 152 or more out of pocket money for subsequent tests in 2017, according to a study published by Fendrick and several colleagues. JAMA Network Open.

People who need testing after some cancer prevention tests and have accumulated charges: half paid $ 155 or more for the virus test after an impressive result on a cervical cancer test; $ 100 is the average for a racist bill after a stool-based cancer test; and $ 424, on average, were charged for subsequent CT tests to diagnose pneumonia, according to additional research by Fendrick and others.

Van Vorhis of Apple Valley, Minnesota, performed a stool test at home to diagnose colorectal cancer two years ago. When the test returns to normal, the 65-year-old retired lawyer needs to have a follow-up colonoscopy to determine if something serious is wrong.

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He consulted his doctor to complain that he had not been warned about the financial consequences of choosing a test to be performed on a stool to measure cancer. If Vorhis had chosen to be tested for the virus in the first place, he would not have paid for it because the test would have been considered anti-depressant. But after a good stool test, “for them it was clearly identified, and there was no reward for testing the virus,” Vorhis said.

He filed a lawsuit before his insurer but failed.

In the development of patients and counselors, people who have commercial insurance and, like Vorhis, require colonoscopy after a positive test or a so-called direct visual examination such as CT colonography will no longer cost from pockets. According to federal regulations for health care years starting after May 31, follow-up testing is considered an important part of immunization testing, and patients can not be charged at all. health system.

The new law could encourage more people to get tested for colorectal cancer, say cancer experts, since people can do stool testing at home.

Nine states have already required such coverage in their plans. Arkansas, California, Illinois, Indiana, Kentucky, Maine, Oregon, Rhode Island, and Texas do not allow patients to be charged for following a colonoscopy after an improved stool base. try, according to Fight Colorectal Cancer, an advocacy group. New York recently passed a bill that is expected to be signed into law soon, said Molly McDonnell, the organisation’s director of publicity.

In recent years, consultants have also stepped up efforts to eliminate cost sharing for breast cancer detection services. A federal bill that would require health plans to cover the diagnosis of breast cancer without dividing patient costs — as they do for the prevention of the disease — has partial support but has not gone ahead.

Meanwhile, smaller states — Arkansas, Colorado, Illinois, Louisiana, New York, and Texas — are making progress on this issue, according to Susan G. Komen, an advocacy group for breast cancer patients. work to get. these rules apply.

This year, 10 more states have introduced similar federal legislation, according to Komen. In two of them – Georgia and Oklahoma – the levels are over.

These state laws only apply to state health plans, however. Most people take responsibility for the burden, financial plans set forth by the federal government.

“The first problem we got was from insurers,” said Molly Guthrie, vice president of politics and advocacy at Komen. “Their argument is expensive.” But, she said, there is a significant cost savings if breast cancer is diagnosed and treated early.

A study that examined claims data after the diagnosis of breast cancer in 2010 found that the average earnings for people diagnosed with stage 1 or 2 were more than $ 82,000 a year after diagnosis. When breast cancer Diagnosed in stage 3, the average price went up to about $ 130,000. For people with type 4 diabetes, the cost in the following year exceeds $ 134,000. Disease levels were determined based on the size of the virus and its spread, among other factors.

When asked to provide a vision for health plans regarding the elimination of cost sharing for the next test after a negative outcome, a spokesman for the health insurance trade declined to comment further.

“Health plans have outlined their benefits to improve affordability and access to quality care,” David Allen, AHIP spokesman, said in a statement. “When patients are diagnosed with a medical condition, their treatment is covered according to the system they choose.”

In addition to looking at cancer, many preventive measures The U.S. Department of Health and Human Services recommends and must be covered without charging patients under the Affordable Care Act if they meet certain age or other screening requirements.

But if health plans are needed to close the cancer screening test without charging patients, does it eliminate cost sharing for future testing after other types of immunization tests — for internal aortic aneurysms, for example? for example — will it be in the past?

Come on, said Fendrick. The health system can take these costs, he said, if there are some unsupervised preventive care, such as maternity. cancer looking at women in most women over the age of 65, is discontinued.

“This is a slippery slope that I really like to do jumping,” he said.


The fee may increase if a free cancer test shows a potential problem


2022 Kaiser Health News.
Distributed by Tribune Content Agency, LLC.

hint: Immunization care may be free, but follow-up research tests may result in significant funding (2022, June 17) returned June 17, 2022 from https://medicalxpress.com/news/2022-06- free-follow-up-diagnostic-large-money.html

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