Women’s Health Screening Available ... If You Pay

On July 22, 2024, I received a letter from a doctor Daniel West (not my doctor) at the Endeavor Health Breast Imaging Center. It said in part,

“Your mammogram shows that your breast tissue is dense. Dense breast tissue is very common and is not abnormal. Dense breast tissue can make it harder to find cancer on a mammogram. Also, dense breast tissue may increase your breast cancer risk. This information about the result of your mammogram report is given to you to raise your awareness.

In patients with dense breast tissue, we offer whole breast screening ultrasound (ABUS) as a supplemental screening exam. ABUS is an FDA-approved radiation-free procedure. When ABUS is used in conjunction with mammography, it can improve the accuracy of your breast cancer screening … If you have not already had or scheduled an ABUS exam and would like to proceed with the ABUS, contact Endeavor Health to schedule your appointment. Be sure to contact your insurance carrier to determine your financial responsibility.”

Of course, I called Endeavor Health to schedule the ABUS screening. I had this procedure before but was told last year that Medicare no longer covered it. But the letter from Doctor West implied that I could have it. Technically, he was right. I could have it, but for the low, low price of $550.

They must be kidding. How many women on Medicare can afford that? I asked my internist for a referral, thinking if she did this, Medicare would have to cover the cost. Instead, she claimed the ABUS screening was unnecessary as there were many false positives, and that there was nothing she could do to get Medicare to cover the cost.

I let it go until one of my best friends, who is exactly my age, had breast cancer discovered by an ABUS screening.  Now, I felt it would be a good idea to get one. A friend told me a place called Bright Light Imaging only charged $250. After confirming this was true, I plan to schedule one there in the near future.

Still, $250 is a lot to pay for a test that many insurance plans still cover. Just not Medicare. Up to 48% of women have dense breast tissue, which makes it harder for a radiologist to see small changes that could be related to cancer. A breast ultrasound (ABUS) is not super costly for a hospital, as the machine is already there. When combined with the traditional mammogram, a study revealed that finding cancer increased from 74% with mammogram alone to 96% when both studies were used. Yet Medicare has decided ABUS is not a screening test and will only cover the cost if a diagnostic medical code explaining that it is needed due to a symptom or abnormal exam is used.

All of this leaves me feeling pretty angry. It is hard to believe that Medicare won’t pay for a test doctors recommend. It is also hard to believe that the $550 fee, or even the $250 one, is needed to cover the cost of the technician who administers the test and the radiologist who reads it. Would a comparable screening test for cancer in men not be covered by Medicare? I wonder.