Ethics is knowing what you have the right to do and what is
right to do.
~Potter Stewart
As I walked inside the imaging and breast care center at the
Women’s Hospital, I made sure I had all of my necessary information. I had my insurance card (premium paid, deductible
paid, etc.) as well as my ID and a solid case of nerves. It’s never easy, going in for testing. Even if it’s something considered
routine. As a woman, testing/screening is often embarrassing and invasive. I have a history of breast
cancer in my family (my father’s mother) therefore I know it’s something I have
to do. As women, we should do it anyhow,
history or not.
I was greeted by a very kind receptionist who asked me to
sign in and then turn around and address the machine (I had thought it was an
ATM) behind me to check in. I entered my
answers to the various questions and scanned my palm (technology!)
I then turned back to the receptionist who proceeded to ask
me if I wanted the 3D imaging. She had
asked the question so quietly, I thought she’d asked me if I wanted a 3 day
image. I asked her to repeat her
question and she again asked if I wanted 3D imaging. Before I could answer, she
informed me that my insurance does not cover it and only covers 2D imaging. She informed me of this with her eyes down,
seemingly embarrassed to pass along the information. I asked what the difference was and again she
sort of mumbled and said that “3D is better than the other”. I asked what my cost would be for the 3D
imaging and she quickly and quietly said that my out of pocket is around
$1000.00.
Seriously? I was flummoxed. I had insurance. I paid my premium, deductible, copays, co-insurance,
etc. Surely this is a mistake. But I was shocked, unsure and a little confused at
having to pay $1000.00 up front in order to have the test. I told her 2D was fine and I went and had a
seat in the waiting room.
My stomach started to hurt as a recalled a conversation I'd had with my doctor a week ago. My doctor wanted me to have an MRI due to severe headaches, pain, blurry vision, pressure, etc. But that unless I had multiple ER visits, my insurance would not cover it. She stood there helpless to help me. I asked her, “So you are telling me that my health insurance company is deciding my health care plan and course of testing and treatment?” She said that yes they were and there was nothing she could do.
My name was called and I walked back to a rather nice,
smaller waiting area. The television had
a news program playing and there was fresh coffee to drink. A cheerful tech told me to change in to a
gown, “nothing on from the waist up.”
Miracle upon miracles – THE GOWN FIT!
I repeat – THE GOWN FIT! My
fluffy, large breasted sisters know the struggle of ill-fitting hospital
gowns. Don’t even get me started about
the PAPER gowns at the gynecologist’s office.
Seriously. The tighter you wrap,
the more it tears. By the time the
doctor comes in, I have a crazed, panicked look in my eyes and look like I’d
had some sort of breakdown in my shredded, too small, now sweaty from trying to cover myself up, paper “gown.”
After I had changed, I opened the door and was greeted by
the same friendly tech and was told to follow her across the hall. I gathered my belongings and stepped into the
mammogram room. The lights were
dimmed. It was a pleasant
atmosphere. She went over my
information.
As she was doing this I
couldn’t help feeling panicked. My mind
was racing! This is my health. I have a history of breast cancer in my
family. Do I pay for the 3D
imaging? Can we afford it? What should we not pay this month so that I
can have this testing? Oh my God! What about the people who can’t even think
about being able to afford it?
I asked the tech to please explain the difference between a
2D and 3D mammogram. She said the simple
answer is, “A 2D mammogram is like an x-ray.
A 3D mammogram is like a CT scan.
It will show everything much more clearly in slices and create a more thorough
diagnostic picture.”
Who wouldn’t choose to have the 3D image? Why is 2D even an option if there is a
better, more effective diagnostic tool?
She could see I was struggling. She asked what insurance I have. I told her I had Humana through the Obamacare
Marketplace. She said that no Humana
plan purchased through the Obamacare Marketplace covers 3D imaging. She said with a history of breast cancer in
my family, if insurance and money wasn’t an issue, she would get the 3D
herself.
Standing there, shivering (mostly from frayed nerves), in my gown I
had to make a decision between my health and my family. Will my family go without so that I can have
the appropriate testing? I asked if she
would please check and see the definite cost of the 3D image. She very kindly said, “Sure” and went up
front.
When she returned she said if I paid in full today, it was
be $297.00. If I paid only half it would
be $167.00 now and $167.00 later. I
quickly texted my husband to check our bank account and then told her I will go
ahead and pay full price and get the 3D.
She said that since I was already in a gown, I could pay after. Um, thanks?
The mammogram was completed in a matter of 10 minutes. She placed markers on my nipples. (They look like little band aids.) She then placed each breast, one at a time, on the tray and slowly cranked down the machine. It was slightly painful, more pinching then
anything. I was asked to briefly hold my breath and then it was over. She was kind, discreet, gentle
and patient.
I was escorted back to the smaller waiting room where I
changed back into my clothes and then was escorted to the front desk to pay.
I handed the woman my bank card, hands shaking, still confused
at everything that transpired. She
handed me back my card and a printed receipt.
I tentatively asked if this receipt showed that I had paid in full. She said, “Yes, but you may still get a bill
from the radiologist that reads the mammogram.”
Are you kidding me?
I came to this appointment assuming that since I had health
insurance, I would get the appropriate testing and that it would be
covered. I mean, don’t all women deserve
to have a mammogram? The "better" diagnostic mammogram?
According to BreastCancer.org 1 in 8 U.S. women will
develop invasive breast cancer in her lifetime.
1 in 8!
Why then, is the INSURANCE company deciding our health
care plan?
Why is the INSURANCE company deciding what tests we are
“allowed” to have and what tests THEY decide to cover?
What are we paying our (very high) premiums for?
What are we paying our outrageous deductibles for?
What are we paying our ridiculous co
insurance and co pays for?
And, what in the heck happens if, God forbid, I or anyone in my family gets really sick? If the insurance company won't pay for a test that my doctor deems necessary, that I now have to pay out of pocket for - how will I afford further testing, treatment, medication, etc.?
I sat in my car shaking with anger and bewilderment. I am furious at a government that allows the
health insurance companies to determine our fate and decide our health care
plan. I am angry at a government that
promised healthcare for all but really meant healthcare for those who can
afford it. After premiums, copays, co-insurance,
deductibles, etc. who has money left over to pay out of pocket for testing,
treatment or medications?
Affordable Healthcare Act? Can our lawmakers really say that with a straight face? Of course they can, THEY can afford it!
How is this morally acceptable?
I took to Twitter to voice my frustration:
We
shouldn't have 2 worry abt becoming sick/dying because we can't afford
tests/trtmnt/meds ins co wont cover. @Humana
@POTUS @BarackObama
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My dr
ordered MRI (headaches, blurry vision, etc.) INS co @Humana won't cover. I don't have 10K OOP.
I pay my premium. @POTUS @BarackObama
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Who
is better able to determine my health care? Dr or ins co? Why r ins co given so
much power? @Humana @POTUS @BarackObama #ethicallywrong
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1
pycheck away from no #healthcare,
ability to pay premium/copay/coins/deductible, tests, meds. @Humana @POTUS
@BarackObama #whendoesitstop
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Grateful
I can afford #marketplace
ins @Humana premiums+deductible+copays+coins.
What about the MILLIONS that can't? @POTUS
@BarackObama
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Ethically/morally,
why is it acceptable that a health ins co @Humana
decides whether we live or die-life saving test or food 4 fam? @POTUS
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I'm
just 1 person in a sea of people whose health plan is decided by their
INSURANCE co!Not dr. This is insane! @POTUS
@BarackObama @Humana
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According
to my #mammogram
tech no @Humana plan will cover 3D
imaging for women. None. What r we paying for? @POTUS @BarackObama #notok
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Why r
the health ins co deciding my health care? My dr is frustrated at this. She
can't order tests because ins won't pay! @Humana @POTUS
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They
were able to do the #upcharge
3D #mammogram
for $297. That is a life or death decision for some ppl! @Humana @POTUS
@BarackObama #notok
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Why
do women have to pay for better standard of care? We are already paying monthly
premiums+deductibles+copays. @Humana
@POTUS @BarackObama
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My
husband is disabled. I pay out of pocket monthly 4 my ins +yrly deductible. Why
isn't 3D covered? #mammogram
@Humana @POTUS
@BarackObama
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Why
do I have to decide between my children being fed or paying for a better #mammogram? @POTUS @BarackObama @Humana #marketplace
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Why
is 3D imaging for women w a familial history of breast #cancer not standard FREE
care? @POTUS @BarackObama @Humana
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Why
is #marketplace
ins allowed to do this? Grateful I cld pay. What abt those who can't w a
history of breast #cancer?
@POTUS @BarackObama
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Yearly
#mammogram.
Just found out AT my appt #marketplace ins
does not cover 3D. Only 2D. @POTUS
@POTUS My out of pocket is 1k!
Within a few minutes of my Tweeting, Humana messaged me saying they wanted to check into this and
to give them my name, zip code and phone number, which I did.
I was contacted by a rep who informed me that 3D imaging is NOT covered under the Affordable Healthcare Act for preventative screening. I am told it is only used for "further diagnostic purposes." Even though it is considered a "better" preventative tool.
Me: "So you are telling me that there is a better preventative test to diagnose breast cancer but you refuse to cover it?"
Rep: "The government under the Affordable Healthcare Act needs to change the law before we can cover it."
Me: "No. You, the insurance company, need to decide on your own that women deserve better, more thorough testing and take it upon yourselves to decide to cover it."
Rep: "Yes, that's true. But I don't make the decisions."
I'm told she will be looking into why an MRI isn't covered for severe head pain, dizziness, blurred vision, etc and why a 3D mammogram wouldn't be covered with a family history of breast cancer.
I voted for and believe in my president to do the right thing.
I will not stop speaking up for myself, for women everywhere
who deserve to have appropriate healthcare deemed necessary by their DOCTOR.
For ALL people who were promised affordable healthcare - and
never received it.
For myself and for women everywhere –
I CHOOSE LOVE!
