KFF’s ‘Bill of the Month’ highlights $1,200 out-of-pocket charge for a breast MRI
KFF Health News is highlighting a troublesome $1,200 out-of-pocket charge for a breast MRI in its “Bill of the Month” feature.
The news site first launched the crowdsourced investigations back in 2018, seeking to dissect and better explain medical bills to consumers. In the latest installment published Aug. 26, KFF (short for the Kaiser Family Foundation) details the case of Stephanie Halver, a 43-year-old Vancouver, Washington, woman who faces a higher risk of developing breast cancer.
Halver’s primary care doc advised her to begin undergoing annual breast MRIs, serving as an additional safeguard if regular mammograms missed the disease. However, after undergoing one last September she later received a bill saying she was on the hook for $1,191.10 after an insurance payment of $13.90.
“I’ve had many phone calls trying to understand,” she told the news website.
This after the scan, delivered by the Vancouver Clinic, had been recommended by her doctor and preapproved by Blue Cross Blue Shield of Texas, of which she is a beneficiary through her employer-sponsored plan. Not to mention, a state law in Washington requires insurers to cover breast MRIs.
BCBS of Texas declined to answer questions about the bill and in July denied her appeal to have the MRI covered. A conversation with her HR department informed Halver that mammograms are covered as a preventive screening, but breast MRIs are not, with the scans subject to deductibles, coinsurance and other cost-sharing.
“I think I’m on the hook for this bill,” she told KFF, adding that since she is recommended for one annually, “that’s a guaranteed bill every year."
Read more from KFF Health News:
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.