To request Mental Health
Services or to access Mental
Health Crisis Services Call:

Health Policy & Advocacy
Basic InformationMore InformationLatest News
Almost 13 Million Americans Per Year Skip Meds Due to CostAssistance Dogs Bring Big Boost to Deaf PeopleCDC to Toughen COVID Testing for International TravelersOld Spice, Secret Antiperspirants Recalled Due to BenzeneClinical Trials Are Becoming More Diverse, But There's Still Work To DoRural Hospitals' ERs Just as Effective as Urban Ones: StudyKraft Recalls Powdered Drinks Over Metal, Glass ConcernsVials Found in Lab Contained Vaccine, not Smallpox Virus: CDCAdvances in Care, Impact of COVID Highlights of Latest Cardiologists' MeetingAcross America, Black People Have Worse Health OutcomesVials With Smallpox Labels Found at Vaccine Lab in Pennsylvania: CDCWhite House to Spend Billions to Boost COVID Vaccine SupplyAHA News: Health Class May Influence Heart Risk in South AsiansPfizer COVID Pill to Be Made, Sold Cheaply in 95 Poor CountriesFederal Court Backs Stay on COVID Vaccine Mandate for Large BusinessesMore Than 2 Million COVID Home Test Kits Recalled Due to False Positive ResultsIn Canada, Ban on Menthol Cigarettes Had More Smokers QuittingOklahoma Supreme Courts Overturns $465 Million J & J Opioid RulingPandemic Puts 'Outdated' Infection Control Practices Under ScrutinyMillions of Tons of COVID Masks, Gloves Will End Up in OceansSales of Unproven, Unapproved Stem Cell Therapies Are BoomingCourt Temporarily Blocks Biden’s Vaccine Mandate for Big BusinessesU.S. Reopens Borders to Vaccinated Foreign TravelersIt's Time to Replace Your Smoke Alarm BatteriesAHA News: How Doctors Can Help Their Patients Make Heart-Healthy Lifestyle ChangesWhite House Sets Jan. 4 Deadline for Large, Private U.S. Companies to Mandate VaccinesHepatitis B Shots Advised for All U.S. Adults Under 60Supply Chain Issues Bring Shortages of Drugs, Devices to U.S. HospitalsMedicare Could Negotiate Drug Prices Under Democrat ProposalWe've Been Here Before: How Polio Vaccine Rollout Saved Millions of Young LivesAlmost 1 in 3 U.S. Seniors Now Sees at Least 5 Doctors Per YearLanguage Can Make the Difference Between Home, Hospital Care: StudyAttorneys General Warn About Pot Products That Look Like Halloween TreatsCDC Lowers Threshold for Lead Poisoning in Youngest KidsStronger Breast Implant Safety Measures Announced by FDAWalmart Recalls Room Spray for Rare Bacteria That Sickened 4, Killing 2U.S. Gun Violence Rates Jumped 30% During PandemicMandates, Not Recommendations, Work Best to Get Folks Vaccinated: StudyU.S. Has Shared 200 Million Shots With Other CountriesLittle Change Seen in Americans' Use of Mental Health Services During PandemicWomen Doctors Face Higher Levels of Harassment, Frustration: SurveyEPA Plans New Strategy Against PFAS 'Forever Chemicals'State Spending on Poverty Really Pays Off for Kids: StudyState Lotteries Didn't Help Boost Vaccination RatesVaccinated Foreign Travelers Can Enter United States Beginning Nov. 8Despite Pressures of Pandemic, U.S. Nursing School Enrollment ClimbsBiden Administration to Invest $100 Million to Ease Health Worker ShortageFDA Warns Against Using At-Home Dermal Filler 'Pens'Death Threats, Trolling Common for Scientists Who Speak to Media About COVID'Extreme Heat' Days Have Tripled Since 1980s, and More Are Coming
Questions and AnswersLinksBook Reviews
Related Topics

Health Insurance

Your Free Cancer Screen Shows Trouble: What If You Can't Afford the Follow-Up?

HealthDay News
by By Alan Mozes HealthDay Reporter
Updated: Oct 12th 2021

new article illustration

TUESDAY, Oct. 12, 2021 (HealthDay News) -- Just over a decade ago, the passage of the Affordable Care Act (ACA, or Obamacare) made many common cancer screenings free. But a pair of new studies caution that when those free tests turn up signs of trouble, important follow-up tests may be too pricey for some patients.

The bigger concern: Some patients may forgo these expensive tests, even when they may prove lifesaving.

"With the Affordable Care Act provisions, any United States Preventative Services Task Force [USPSTF] Grade A or B recommendations are covered at no cost," explained Dr. Tina Tailor, lead author on one of the studies. "This includes a number of things, but some example of screening tests would include mammography, colon cancer screening, lung cancer screening and cervical cancer screening."

And the move towards cost-free screening "is a fundamental step in enabling access to preventive care," said Tailor, who is an assistant professor of radiology at the Duke University Medical Center in Durham, N.C.

Her study honed in on the cost of lung cancer follow-up tests and was published recently in the Journal of the American College of Radiology.

"Specifically, this refers to various types of biopsies, including surgery," Tailor explained. "A minority of patients would need these types of follow-ups. In the population studied in our investigation, approximately 7%.

"We found that individuals requiring downstream invasive testing after their [free] screening examination paid anywhere between $0 to approximately $7,500 out of pocket," she noted.

Four in 10 patients who underwent a post-lung cancer screening procedure didn't pay anything for their follow-up; the other 60% had to cough up cash to do so.

The second study, published recently in the journal Obstetrics & Gynecology, focused on the costs of a follow-up exam following concerning results from a Pap smear, HPV test or routine cervical exam.

Called a colposcopy, this type of exam may include a biopsy and a range of other gynecologic procedures.

Led by University of Michigan internal medicine professor Dr. A. Mark Fendrick and ob-gyn assistant professor Dr. Michelle Moniz, the investigation found that women undergoing a colposcopy had to fork out an average of $112 for the procedure alone.

If cells were extracted for further analysis, that figure rose to $155, the team found. And when a further analysis ended up involving a biopsy, the additional financial hit to patients could be as high as $1,000, based on 2019 figures.

"Costs much lower than these have been shown to prevent women from obtaining recommended health care," Moniz said in a university news release. "So it is high time we consider eliminating financial barriers to recommended care to prevent cancer."

What can be done? "We need to think about innovative insurance design and health policies that go beyond no-cost provisions for the initial screening test," said Tailor, who called ensuring for adequate coverage for all follow-up testing and procedures, given their critical and often lifesaving roles.

That call was seconded by Katie Keith, a research faculty member with the Center on Health Insurance Reforms at Georgetown University, who also runs Keith Policy Solutions in Washington, D.C. She stressed that the concerns stem from the way insurance companies currently process reimbursements.

"I would not call [this] a failure of the Affordable Care Act, which has dramatically increased access to preventive care and screenings," Keith said. "But additional clarity is likely needed as plans, insurers and providers draw distinctions between 'preventive' and 'diagnostic' care."

This is because "when the care is categorized or coded as 'preventive,' it must be provided without cost-sharing," Keith noted. "But when it is considered 'diagnostic' to, say, confirm prior test results or rule out an abnormal initial screening, patients can be asked to pay cost-sharing."

On that front, there has been some movement, she noted. "For instance, the Biden administration recently issued guidance to confirm that the full scope of [HIV prevention] PrEP-related services -- including certain follow-up care -- must be covered without cost-sharing, not just the medication itself.

"But in the absence of such explicit guidance, plans and insurers have some flexibility in how to define when a service qualifies as preventive, Keith noted. That means that in the end, any "comprehensive solution may require additional congressional action, to ensure the availability of follow-up tests without cost-sharing."

More information

There's more on rules mandating free screenings at U.S. Centers for Medicare and Medicaid Services.

SOURCES: Tina Tailor, MD, assistant professor, radiology, department of radiology, Duke University Medical Center, Durham, N.C.; Katie Keith, J.D., M.P.H.. research faculty, Center on Health Insurance Reforms, Georgetown University, and principal, Keith Policy Solutions LLC, Washington, D.C.; University of Michigan, news release, Sept. 30, 2021; Journal of the American College of Radiology, Sept. 30, 2021; Obstetrics & Gynecology, Sept. 29, 2021