The “Cost” of Screening vs. Diagnostic Mammography

Anyone who’s ever needed a diagnostic test understands that the unknown is often the scariest part. At RAYUS, we feel a commitment to our patients and communities to help shine a light on that unknown. Our collective work combined with the knowledge, dedication and passion of our radiologists changes and saves lives. However, sometimes policies put in place by insurance companies or our state and federal governments can serve as impediments to RAYUS’ (and other providers’) ability to keep patients healthy.

For example, many patients are shocked to find out that while screening mammography must be covered by insurance companies at no cost to patients under the Affordable Care Act, patients are often subject to a copay for diagnostic mammography services. The Komen Foundation estimates that these “surprise insurance coverage gaps” result in nearly 20% of patients simply skipping their test altogether and choosing to live in that unknown – sometimes in addition to the emotional and physical toll of a (potential) breast cancer diagnosis.

A diagnostic mammogram is a more detailed test than a screening mammogram. It is often used to evaluate an abnormality that was found on a screening mammogram or during a clinical breast exam. Diagnostic mammograms provide detailed images of the breast tissue, allowing radiologists to better detect and evaluate any potential abnormalities.

Closing this surprise coverage gap is crucial to ensuring that women have access to the care they need, regardless of their financial situation. Women who are uninsured or underinsured may be particularly vulnerable to the financial burden of health care. Reducing the cost burden through improved public policy encourages women to seek follow-up care if an abnormality is detected on a screening mammogram, which will ultimately lead to earlier detection and treatment of breast cancer.

This is where RAYUS leads the way! In states like Minnesota, Oregon, Washington, Wisconsin and Tennessee, we have partnered with the Komen Foundation and our radiologist partners to introduce and advance legislation to mandate that insurers cover diagnostic mammography at no cost to patients. Our radiologist partners have submitted testimony, provided tours to legislators and have even been featured on local news advocating for our bills.

RAYUS is dedicated to advancing patient-centric public policy and promoting health equity. With that in mind, ensuring that cost is not an impediment to diagnostic mammography access is essential to ensuring that the women we serve have access to the care they need.

Written by: Christopher “Kit” Crancer, SVP, Rad Part & Pol, and Exec Dir of CDI QI, and Zachary Brunnert, Sr. Director, State Legislative Policy