Topic: Denied Insurance-what to do

Forum: Employment, Insurance, and Other Financial Issues — Employment, insurance, and financial concerns are common. Meet others here to discuss and for support.

Posted on: Oct 20, 2010 08:29AM

Posted on: Oct 20, 2010 08:29AM

StephH wrote:

I had breast cancer (DCIS) 2 years ago.  I will be up for my yearly mammogram at the end of Dec.  I moved from AZ to TX in June and went to transfer my health insurance over.  I was denied and I know there are options-high risk pool but that is going to be outrageously expensive for the budget and not doable.  I don't mind paying out of pocket for a mammogram but when I went to make the appointment I was told a doctor would need to order a diagnostic mammogram.  How can I get a mammogram without having a doctor first?  btw-I am 38 yrs old. 

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Oct 20, 2010 10:09AM Bren-2007 wrote:

Hi Steph,

Try contacting your local health department and ask about the Breast and Cervical Cancer screening program.

I am self-employed and had no insurance.  This program saved my life.

Best of luck to you,

Bren

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Oct 20, 2010 10:27AM StephH wrote:

I just pulled up the website.  Here are the eligibility requirements:  uninsured or underinsured women at or below 250% of federal poverty level, ages 18-64 for cervical screening, ages 40-64 breast screening.  As I said, I am 38 & in need of a diagnostic mammogram.  I am not filthy rich nor do I live on the street in a box, sometimes I feel that is the only way to get things in this country.  I should also note I have called lots of hotlines, 1800-4-CANCER, the cdc, CANCER CARE, Patient Advocate, Dept Health, and hospitals.  They can all refer me of where to go for a mammogram, but once I make the appt. I am asked for a dr's name. 

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Oct 20, 2010 11:10AM Medigal wrote:

I thought these new state High Risk programs were supposed to accept you even if you have a pre-existing disease.  The main problem is you have to stay off insurance for 6 months to be able to sign up.  That means 6 months paying for everything yourself.  If you are living now in Texas, why don't you go to your state's site concerning this new government program each state is supposed to have and it will tell you exactly how much your premiums will be.  It should not be exhorbitant for one person.  That is what the Healthcare Bill was to be able.  Helping people in your predicament get affordable insurance when they can't get it privately.  I hope you work this out.  Do you not have even a primary care doctor who could write out a mammogram RX for you?  It doesn't have to come from an Oncologist.  What about these Urgent Care Centers we have now all over the place.  There should be someplace you can get a mammogram without it bankrupting you.  B est of luck!

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Oct 20, 2010 02:59PM lovemygarden wrote:

Oh for the good old days 20 years ago when we could get a blood test, pregnancy test, mammogram, etc by simply going to a lab and paying for it. *sigh* Now we have to jump through hoops and practically sit up and beg for every little thing. Yell

Steph, look in the Yellow Pages and start calling local radiologists offices, to ask if they have any upcoming free/public mammogram programs. One of the big radiology firms (they have 3 or 4 different locations) in my area does this once every 3 months at one of the local hospitals. They offer free walk-in mammograms and also drastically cut-rate (as in $100!) contrast MRIs during these events. What I don't know is whether you still need a doctor's Rx or whether you can just walk in, wait in line, and get one done. If you're lucky they may only require a doctor's name and address to send the results to. 

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Oct 20, 2010 03:07PM Annabella58 wrote:

Steph, go to a local women's free clinic.  Get an OB/GYN free exam.  Ask the dr. there about options.  She should be able to write you a script for a mammo.  Also, if that doesn't work, there should be, as above, free mammograms buses that do come around.  They make it to most states, just google "free mammogram buses" and see what comes up.

Good luck!  I had no insurance at all when I had my first bc in 2001.  If they tell you you must pay out of pocket for it, call the local hospitals' billing dept.  Ask for a "hardship" payment plan.  They by law, must comply and work with you.  This will not be offered unless you ask for it.

 My 80 year old mom just went for her first ever.  She did not have a primary dr. at all, nor a script.  She used that mammogram bus clinic.  They generally park at libraries, or grocery plazas.  The site should have an 800 # you can use to call them.

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Oct 20, 2010 03:51PM - edited Oct 20, 2010 03:52PM by lovemygarden

Unfortunately most "hardship" rates require you to have an income that is laughably low, plus assets that are practically nonexistent. As the OP pointed out most accurately, there is very little help for patients who are in the middle class and trying to stave off being hardship cases.

Here is the catch-22. If you have a test done at a hospital, the "full ticket price" is almost always HIGHER than if you have the same test done at a radiology office. So even if the hospital extends you a 20% discount (which is the usual maximum non-hardship courtesy they will give an uninsured person) the cost of the test may be higher. It's like a store that marks up all their prices and then puts up "big sale" signs.

I have to get a MUGA scan every 3 months because I'm on Herceptin. No insurance. So I shopped around. These are were the rates I got for the exact same test:

Hospitals (I shopped 5, this was the least expensive quote):

MUGA price $850. Less 20% courtesy self-pay discount of $170 = $680. Mandatory NY State surcharge for all services performed at a hospital or billed by a hospital: 9.3%. $680 x 9.3% = $63. Total cost to have my MUGAs done at a hospital: $743.

Radiologist's office: MUGA sticker price $750. Courtesy price for self-pay, pay in full at the time of service: 1/3 off. NY State surcharge does not apply to services done in a non-hospital setting. Total cost to get my MUGAs at the radiologist's office: $500.

We who are uninsured have to constantly ferret out the best prices possible for everything.

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Oct 20, 2010 03:54PM - edited Aug 20, 2013 02:59AM by lago

Have you contacted the local American Cancer Society? They are really good at helping with things like this.

www.cancer.org/ 

www.cancer.org/Treatment/Findi... 

BTW I think the ACS also  has aid for free mammograms. I don't know about the eligibility though.

DONE!! goo.gl/IoaN6U • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010 Dx 7/13/2010, IDC, 5cm, Stage IIB, Grade 3, 0/14 nodes, ER+/PR+, HER2-
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Oct 20, 2010 03:59PM stlrepke wrote:

Is there an issue because it's a Diagnostic and not a Screening Mammogram? Like one of the other ladies mentioned maybe visit or call the free clinic and see if they can write the script for the Diagnostic. Good luck!

Theri - 35 2nd time around BRCA 1 mutation. Dx 9/16/2009, IDC, 2cm, Stage IIA, Grade 3, 0/4 nodes, ER-/PR-, HER2-
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Oct 21, 2010 04:37AM StephH wrote:

YES stlstroller THAT IS THE PROBLEM!!!  The mobile units for free mammos are fine, but I NEED DIAGNOSTIC!!!  You got it!

I found I can get the mammo for $84.00 (fine, no prob) but then they ask for a dr to send the results to or a dr to order the DIAGNOSTIC mammo.  I'm thinking my best bet would be to try the women's clinic for an exam & get that dr to write one.  Maybe that would work, not sure until I try.  Other option is to go uninsured for 6 months then I would be eligible for the pre-existing condition health insurance that is supposedly affordable but not so much.  I would have to wait until April 1 to do this. 

Thanks for all your help.

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Oct 21, 2010 03:52PM AnneW wrote:

Try getting an appointment at the GYN's with a nurse practitioner. Their fees are usually quite a bit lower. She can write for the diagnostic mammogram.

The next question, though, is if you don't have health insurance, what will you do in case that diagnostic mammo leaves you with a less than desireable result? This is the scary part about not having insurance.

Best of luck to you,

Anne

2002 IDC stage 1, grade 1, rads & AI Dx 9/18/2007, ILC, <1cm, Stage I, Grade 1, 0/1 nodes, ER+/PR+, HER2-

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