Mammogram Benefit Valuable

My letter primarily will apply to women, age 40 and older and possibly anyone helping them manage their finances.

At the Gifford Medical Center booth at Tunbridge Fair this year, Jane Harrness, breast care coordinator, asked me if I was aware of a provision passed in this year's legislative session to cap mammogram fees at $25 for the patient. Jane is a dedicated employee of GMC, and an advocate for her Gifford patients to be aware of what they should do about their cancer screenings.

The new law went into effect on Oct. 1.

According to an Associated Press report, studies suggest cost is a factor in whether women seek and receive mammography services. A study in the New England Journal of Medicine found that women are about 8% less likely to get mammograms if they have to pay part of the cost.

In early October, I scheduled my mammogram, and then attentively watched for the invoices. I did not know that the reduction to an individual's bill, would apply to the entire mammogram fees, including the fee for the radiologist diagnosis. My fees had been $520.45 for Gifford and the fee for the radiologist at Fletcher Allen. Initially, these invoices came to me indicating that my insurance provider would pay nothing at all, and that all of these fees would be ap plied to my calendar year deductible.

When I disputed the accounting of these bills, however, Blue Cross/Blue Shield accepted these fees at $396.51, and paid $332.14. In just two weeks, they reviewed this claim, and BC/BS sent me a letter indicating that my "out of pocket" would be the same as my co-pay of $15.

If anyone is having difficulty getting their newly mandated benefit paid appropriately, contact your insurance company to review the payment, or ask your provider to resubmit the bills, mentioning the new cap on mammograms in Vermont. If you get someone who cannot help you, ask to speak to their supervisor.

This is a significant difference in what I was initially billed, and it is important that if someone in your family does not advocate for themselves, you assist them. I believe this legislation to help with early diagnostics should also be mandated to the insurance companies for annual Pap visits for women, and for prostate exams for men.

A yearly physical for obtaining at least the basic care of blood pressure screening, and other standards should be part of what our health insurance covers.

I wish to thank our lobbyists, and our representatives that were in favor of this bill, and to Governor Douglas for signing it.

Anne Silloway Randolph Center