by John R. Fischer
, Senior Reporter | October 11, 2021
For the past 11 years, getting a scan or test to check for early signs of cancer has been freely accessible under the Affordable Care Act for many American adults. But these initial exams can lead to hundreds of dollars in follow-up tests if they turn up an abnormal finding.
Researchers at the University of Michigan and Duke University say the reason may be because patients do not get follow-ups immediately and delay care out of fear of not being able to afford it. Such actions, they say, can allow disease to progress, with patients experiencing worse outcomes and higher medical costs than they would have had they sought follow-up care immediately.
They also say that the findings could be a wake-up call for insurers to do more to reduce the burden of cost on those who require follow-ups. “Costs much lower than these have been shown to prevent women from obtaining recommended healthcare,” said Dr. Michelle Moniz, an OB-GYN assistant professor at U-M, in a statement. “So it is high time we consider eliminating financial barriers to recommended care to prevent cancer.”
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Working with internal medical professor Dr. A. Mark Fendrick, Moniz looked at women over 13 years who paid out-of-pocket for colposcopies, which can lead to a biopsy or other procedures. Those who had one without follow-up tests paid, on average, $112, and those who had cells taken for further study paid $155. Further procedures resulted in hundreds of dollars more, with out-of-pocket cost rising sharply during the course of the study. In 2019, additional care beyond a biopsy cost nearly $1,000.
Another study between U-M and Duke looked at what patients were billed for lung biopsies and other invasive procedures following an abnormal CT scan. Of all patients, 7.4% had at least one follow-up invasive procedure, with 20% of this group diagnosed with lung cancer. The rate of procedures "downstream" of the screening CT was higher than what was seen in clinical trials that showed the value of lung CT screening in certain older adults and resulted in access at no cost in 2013. More than half of patients paid for a follow-up procedure, with some owing hundreds of even thousands out-of-pocket. Forty percent paid nothing.
“Since screening for these cancers often requires multiple steps, health insurers should remove barriers that may create financial hardship or deter an individual from completing the screening process,” wrote authors and radiologists Dr. Tina Tailor, from Duke, and Dr. Ruth Carlos, of U-M’s Michigan Medicine.
A study in April found that a majority of women who undergo mammography for breast cancer screening are willing to pay out-of-pocket for additional screening
like breast MR and contrast-enhanced mammography. Despite the risks associated with both, such as radiation and contrast reaction, more than half of 1,000 patients with dense breast tissue indicated they would spend $250-$500 for an MR scan. An additional 10.3% with dense breasts said they would spend $500-$1,000.
And despite the fact that many insurers waived cost-sharing requirements last year, many Americans may have been faced with high out-of-pocket costs for COVID-19-related care
such as pneumonia and other upper respiratory illness hospitalizations.
Not all patients are covered under the Affordable Care Act for free cancer screenings, meaning that initial screening costs can add to those of follow-ups. Patients should contact their insurer to find out if they are eligible for free screenings.
The findings for the colposcopy study were published in Obstetrics & Gynecology
. Those for lung biopsies were published in the Journal of the American College of Radiology