Everyone knows healthcare costs in the United States is expensive. It is difficult to fathom the financial hardships that folks with serious medical issues face without good insurance. I feel fortunate that I had reasonable insurance through work. My plan was Anthem Blue Cross Blue Shield's High PPO plan. Despite having coverage through the VA, I opted to maintain health insurance in the private sector since I was unsure when I may need more care than what the VA can offer. (Note: My health insurance was registered with the VA so if I did receive care with the VA, they would bill my insurance to recoup costs.) The plan deductible was $500 with an annual out-of-pocket maximum of $3000 for in-network services. For out-of-network, the deductible is a separate $750 with out-of-pocket maximum of $4500, but I don't recall ever having to use out-of-network services. My coinsurance was 20%. The main downside of my plan was that the benefit year went from July 1 to June 30th instead of the more common January 1 to December 31. The timing was such that the diagnostics and treatments would span two benefit years, causing me to hit out-of-pocket maximum twice. Once you hit your out-of-pocket maximum though, the plan pays 100% of covered services thereafter.
Although the cost likely varies between hospitals and whether or not you have insurance, I thought I would provide a sample of what the doctors would bill the insurance. This post covers the cost of just the diagnostics performed since May. Between May and June I had 9 total visits that included the initial mammogram, follow-up mammogram, ultrasound, MRI, and surgical consults. A total of $36,207 was billed to my insurance. The insurance in-network contract allows $11, 234 to be billed for those services. I paid $1671 between copays and coinsurance. The most expensive service was the biopsy which came to $959 out-of-pocket for me. Between the hospital and radiologists, over $10,000 was billed to the insurance for the procedure that took about an hour. If you look at the claim details, one of the line items was treatment room and observation for like $4000. My thought was "what observation"? They sent me right home after the procedure. Out of curiosity I asked the billing department of the hospital about this line item. Their response? "We bill that because we can." One of many reasons why health insurance costs so much in the U.S.
Although health care can be expensive, the Affordable Care Act (ACA) requires most private health insurance plans to cover recommended preventative services without any out-of-pocket costs. If you have insurance, your annual mammogram (if over 40) should be free to you. If you do not have insurance, organizations like National Breast and Cervical Cancer Early Detection Program (NBCCEDP), Planned Parenthood, and Susan G. Komen Foundation can help women find financial assistance or programs that cover the cost of screening.
For those of you on the market for insurance or considering a change in plan during open enrollment, there is a lot to consider. Those who are young and healthy could do well with a high-deductible health insurance with Health Savings Account which offer triple-tax advantage (tax-deductible contributions, tax-free growth, tax-free withdrawals). Health Maintenance Organizations (HMO) usually offer lower cost premiumes but with some restrictions on who you can get care from (i.e. only in-network). Preferred Provider Organization (PPO) costs higher, but offers more flexibility in which doctor you can see. There are also different levels of each type of plans usually, with the most expensive option usually having lower copays, deductibles, co-insurance, and out-of-pocket maximum. Insurance options vary by employer and state marketplace. Everyone's needs are different, but I would encourage anyone without medical insurance in the U.S. to find coverage at the next opportunity. No one expects to get seriously hurt or sick but if you do, you want to be able to get the best care possible without worrying about going bankrupt. If your employer does not offer insurance, check out healthcare.gov to browse plans and costs.
