CC BROWN — Annual Mammogram Scam

Pink Tite The Breast Things in life.After my uneventful annual mammogram in the summer of 2011, I received one of those all too familiar notices from the hospital saying that I needed to come back in for another look at my left breast. I was not upset in any way, but for some reason I made an appointment with a breast specialist in the city instead. I will never forget as I sat in the exam room waiting for the doctor to give me her impression of the films I brought, when the office experienced a power outage. The doctor ran in and asked if I was ok. Though I was not familiar with this doctor, I felt as if her concern were coming from another place. I said, “Did you see anything in my left breast?” She said, “No, but I did see “something” in your right one.”

So started my journey of making good intuitive decisions. If I had gone back to the facility that sent me the notice, they would have checked the wrong side, given me the all clear, and put off detecting what turned out to be a small tumor in my right breast for at least another year.

A dear friend who was an executive at a leading hospital guided me to a fantastic surgeon who believed a lumpectomy suitable. With his talent and the fact that the tumor was as deep as it was small facilitated a remarkable cosmetic outcome. Lymph dissection, all the tests entailed, things only got dicey when it came to radiation. I had the option of choosing Brachytherapy, which would mean inserting a device into the incision site that would deliver the radiation continually for two weeks, then remove it and re-stitch. Or, per my surgeon’s insistence, do full on, traditional radiation for seven weeks. Neither of these options made sense to me. Undo that finite scar? Blast the whole breast causing unavoidable shrinkage and exposing my nearby organs to damage? Both options seemed contradictory.

My brother in law was photographing the new state-of-the- art Perelman center in Philadelphia and mentioned proton therapy as a possible alternative. I called and they apologized that breasts were not yet on the radar for this type of therapy as this body part varies greatly in each individual and is difficult to target. Now that I knew this modality existed, I was determined to see if I could possibly find this targeted beam treatment somewhere. It turned out there was only one place in the entire world that was doing breasts at that time, and they were starting their second clinical trial. We would have to travel 3000 miles to California. With an angel on my shoulder I managed to qualify for that trial, and off we went.

At this amazing facility, they spent time building a cast for my breast so they could specifically pinpoint the radiation. I was the only woman there at that time, but met many men from all over the world who were receiving proton radiation for their prostate. It has been almost five years now and I am comfortable with my unconventional personal decisions, including not taking Tamoxifen.

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The anxiety, however, comes on a yearly basis with the trip to the oncologist and my mammogram. This year, like the others, my doctor wrote the prescription on, or around, the anniversary of the previous year’s test. As usual, the technician got annoyed at my request for the thyroid guard and had to untie it from the back of the door where it apparently resides without use. We got started, and then she stated she had to repeat some pictures… my heart began to pound. When she finished I went to sit in the waiting room with the other anxious women, perspiration running down the sides of my gown. I heard them call for a doctor… and just thought… oh god, please no…. A very long ten minutes later I was summoned to the office where the physician reviews the results. She immediately said everything looked good, prompting me to thank her as if she had spared me a prison sentence!

Weeks later, I was not expecting the next cause of stress to come in the form of a bill for this recent mammogram. Certainly a mistake, I thought. Any woman can climb in a mobile unit these days and receive a mammogram for free. I pay almost a thousand dollars per month for my premium individual plan and have never had to pay for my mammogram.

I called the hospital to let them know there had been a mistake. I was told no mistake. They said my insurance is not paying for this mammogram and it was my responsibility. Okay… so I called the insurance company, and indeed they said they were not obligated to pay. I called back when it hit me that this same insurance company had paid for my mammogram the year prior.

To my disbelief, I was told that the prior year’s payment had been a mistake. I could not get a clear answer as to why I was being denied other than that they did not cover “diagnostic” mammograms. They didn’t seem to understand that this was my annual mammogram and that I was not having a problem.

About the third phone call it was explained to me that my physician had entered a diagnostic “code” that rendered me not covered. How could that be? My doctor deals with women who need mammograms every day… impossible! I started to be unpleasant and grew angry with each new contact, knowing and hoping these phone calls were being recorded and monitored. I started using terms such as “discrimination” and “unfair practice” when it became clear that I was being denied only because of my prior breast cancer.

As things stood, I would never be covered again as long as I live. I don’t think this was what Hillary and Barrack were trying to achieve, and in fact the total opposite.

Finally, I got a supervisor who was willing to listen and hand me the golden ticket—the prescription code that would allow me to be recognized as an average woman receiving her annual mammogram. Armed with her validation, I asked if she could please do one more thing and stay on the line while we called the radiology department together. We put the call through to the individual in charge of that area, to whom the insurance rep clearly stated that she would be willing to support and witness changing the code, thus guaranteeing coverage for this service. We went back and forth, and I could not fathom the downside. I would be covered, and the hospital would be paid. Not so fast… the radiology employee refused any responsibility in the matter believing she would be breaking the law. She put it back on my physician to find a way to change the code after the fact.

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I called my doctor directly and implored her to change that damming code, explaining the ramifications not only for myself, but also for every other patient she has with prior breast cancer. She informed me she could not change it because of its technological nature and because of the computer system she relied on. She promised to speak with the powers that be and I believed her.

A few days later I received a call from a woman named Roseanne… thanking me?

Yes, thanking me for shedding light on this issue and apologizing for any stress it had caused me (she definitely must have listened to the recordings). As it turns out, I would not be receiving any more bills as it was taken care of, and the radiology department was having a meeting to correct and clarify procedure moving forward. I felt good. Two weeks later the insurance company mailed an addendum to their plan regarding mammograms: they were eliminating the discriminatory factor of prior breast cancer as a reason to prevent coverage for annual screenings.

by CC Brown

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