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Speaking of mammograms--what does this mean?

6 years ago

I just finished responding to Lily's worrisome post about her mammogram when I got my mail. I received a summary of benefit changes letter from my health insurance carrier. Here's is one of the changes:

Women's Preventive Services--Diagnostic Mammography

Date on or after January 1, 2018 when your plan benefits take effect.

Language has been updated to remove diagnostic mammography as a preventive service.

HMO, POS/DPOS, EPO/Closed Panel PPO, PPO

WHAT DOES THIS MEAN?

THANKS,

Annegriet

Featured Answer

Chi

6 years ago

last modified: 6 years ago

I think preventative and diagnostic mammograms are different. I think the diagnostic ones are when a physician thinks there's a problem, while the preventative ones are just screening. It could be something as simple as the diagnostic ones no longer being covered as a preventative service, and so they will be subject to the deductible when previously they weren't. Preventative screenings should still be covered fully but I would definitely call and ask.

My more cynical side thinks this is the beginning of Trump dismantling anything with Obama's name on it at the cost of the health of Americans. We will slowly see protections revoked, coverage decreased and premiums increased.

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Comments (7)

DawnInCal
6 years ago
It sounds like your insurance company is no longer going to pay for mammograms as a preventative service. I wonder if they are also going to include colonoscopies for cancer screening on their list of things they no longer cover?

Those are among several screening tools that were covered under Obamacare, but I haven't heard that the powers that be in Washington have eliminated those...yet.
Annegriet thanked DawnInCal
lindaohnowga
6 years ago
I don't know if you are of age to be on Medicare, but Medicare has always covered a routine mammogram once a year. From the sounds of what you received, it sounds to me like your regular insurance won't be covering mammograms starting in Jan. 2018.
Annegriet thanked lindaohnowga
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chisue
6 years ago
In other countries, women over 70 with no history of breast cancer are not covered for 'preventive' mammograms. About time, IMO. Hospitals buy this expensive equipment and want to make money using it.

Studies have shown that mammograms have resulted in more women having damaging 'interventions' than the number who were 'saved'. This makes me wonder how many women who believe they are breast cancer survivors never needed the painful and costly interventions they experienced.
Annegriet thanked chisue
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MDLN
6 years ago
Agree w/ Chi. Preventative services (screenings) usually have a higher coveage rate (e.g., 100% even before deductable); diagnostic coverage depends on your plan.
Annegriet thanked MDLN
PRO
MDLN
6 years ago
last modified: 6 years ago
@ chisue, The USPSTF, which issues national evidence based guidelines, does not recommend screening after age 74.

However, the American Cancer Society lists no age limit.
Annegriet thanked MDLN
DawnInCal
6 years ago
last modified: 6 years ago
The way the insurance company has worded their sentence is awkward.

Language has been updated to remove diagnostic mammography as a preventive service.

I wouldn't call a diagnostic mammography a preventive service; I would consider it a procedure to diagnose suspicious findings in the original preventive mammogram. Perhaps that's why they are removing diagnostic mammography as a preventive service as it was never meant to be a preventive service in the first place.

The way they've worded that is confusing and what they mean is not entirely clear to the reader. Or, maybe it's just the way I'm reading it?
Annegriet thanked DawnInCal

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