Follow-up recommendations after abnormal mammograms often ignored due to high deductibles
High insurance deductibles are preventing many women from completing follow-up recommendations after abnormalities are uncovered on their screening mammograms.
In fact, as many as one in five women forego follow-up exams if a high deductible is involved, according to a study presented this week at the annual meeting of the Radiological Society of North America.
Lead author of the study, Michael Ngo, MD, radiology resident at Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, explained that although the Affordable Care Act eliminated out-of-pocket costs for screening mammograms under most insurance plans, that coverage does not carry over to the additional exams that are needed when abnormal findings are uncovered during screenings.
“If the radiologist detects an abnormal finding on the screening image, then additional images and a biopsy are needed to determine if the patient has cancer,” Ngo said. “The ACA does not mandate insurance to cover the costs of these additional services.”
The rising cost of insurance premiums has prompted many women to opt for high deductible health plans (HDHP) that cover routine and preventative care but leave additional medical expenses in the hands of patients until the deductible has been met. For healthy individuals who do not routinely need added coverage, these plans can be a money saving option. That is, until something like an abnormal mammogram comes up and additional imaging, labs, biopsies and potentially treatment are needed.
Prior studies have found that OOP expenses often prevent patients from seeking medical treatment and/or complying with physician recommendations. With this in mind, Ngo and his team sought to understand whether HDHPs, which result in additional expenses for patients when anything outside of a normal screening occurs, might deter women from following through with radiologist recommendations in the event of abnormal mammographic findings.
This involved a survey of 932 patients presenting for breast imaging at Boston Medical Center between September 2021 and February 2022. While nearly 60% indicated that they would complete follow-up recommendations regardless of their deductible and OOP expenses, 21.2% shared that they would forego the exam and 19.5% were unsure of what they would do in the situation.
The women were also questioned about whether they would skip their annual screening if it would result in OOP expenses. That question yielded similar responses, with 18.3% saying they would skip the exam, while 16% were undecided and 65.8% indicated that OOP expenses would not deter them from completing the screening.
According to demographic data gathered for the study, the women who were most likely to forego follow-up examinations were Hispanic, had completed less formal education (high school or less), had lower incomes and were either uninsured or on Medicaid—a finding that Ngo suggested should be considered on a legislative level when comprising coverage mandates.
“Our study demonstrates that out-of-pocket payments will discourage people, especially those belonging in the most vulnerable populations, from completing the last steps in the breast cancer screening process,” Ngo said. “These results could be used to advocate for legislation that will cover these important follow-up tests and prevent further exacerbation of existing health inequities.”
To learn more about RSNA 2022, click here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.