Mammogram

RECENT POSTS

Explaining the Health Insurance ‘Explanation of Benefits’

By Lynne Shallcross

We are wrapping up the first phase of our PriceCheck project. The goal is to shine a light on costs of common health care procedures in California. We’re starting with screening mammograms, and already we’ve found that the cash price (for people who are uninsured or have gone out of network) varies from a low of $60 at the H. Claude Hudson Comprehensive Health Center in Los Angeles, a county-run clinic, to $801 at U.C. San Francisco on the high end.

Together with KPCC in Los Angeles and ClearHealthCosts.com, we’re also asking you, the members of our community, to share what you’ve been charged — and what your provider has been paid — for common health procedures.

In order to do that, you need to get familiar with your insurance company’s “explanation of benefits” or EOB. That’s the form your insurer sends to explain what was paid, to whom, at what level and why.

Here’s a typical EOB, that we’ve marked with some explanations below:

An explanation of benefits from Anthem Blue Cross.

An explanation of benefits from Anthem Blue Cross.

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PriceCheck: What Insurance Companies Are Paying for Mammograms

(Illustration: Andy Warner)

(Illustration: Andy Warner)

It’s been almost three weeks since we launched our PriceCheck project, and women statewide are continuing to share what they — or their insurance companies — have paid for a mammogram.

Is your insurer paying $134 or $1,200?    

I talked about PriceCheck and our most recent data with Rachael Myrow on The California Report Thursday morning.

It’s been fun to see people’s mouths fall open when I tell them the range we’re seeing that insurers pay for mammograms across California:  $134 on the low end to $1,200 on the high end. Continue reading

Cutting Down on Cancer Overdiagnosis: National Panel Weighs In

Ductal carcinoma in situ seen under a microscope. While doctors also call it Stage 0 Breast Cancer, in an article Monday, doctors argue it should no longer be labelled "cancer." (Ed Euthman/Flickr)

Ductal carcinoma in situ as seen under a microscope.  Doctors also call D.C.I.S. “Stage 0 Breast Cancer.” But in an article Monday, a panel of national scientists argue it should no longer be labelled “cancer.” (Ed Euthman/Flickr)

What power does a word have? If the word is “cancer,” for most people it packs a wallop of emotion ranging from general anxiety to abject terror. For the last 30 years, a large industry has grown and developed with a focus on awareness and screening. The goals were laudable: get screened; catch cancer early; early diagnosis means patients dodge a death sentence.

There’s just one problem. It’s not working. This notion of screening was dependent upon the understanding of cancer 30 years ago: that cancer started from a tiny seed and steadily grew and spread until – without treatment – it killed the patient.

But today scientists know that not all cancers behave this way. Some are fast-growing, some may grow slowly, but progressively. But others are “indolent,” so slow-growing, they will never cause the patient harm.

So what certain cancer screening tests have wrought (think mammography, PSA tests) is a dramatic increase in diagnosis of early-stage disease without a corresponding decline in death rates from cancer or diagnosis of late-stage disease. Many of these early stage patients are likely “overdiagnosed” and then “overtreated” — for cancers that may never have grown and spread.

“We terrify (women) with D.C.I.S. thinking they have cancer. We could wait six months to see if something changes without making people hysterical.”
Against this backdrop, the National Cancer Institute called together a group of nationally recognized cancer doctors and researchers to review the evidence on overdiagnosis. In a Viewpoint published Monday in JAMA, the panel calls for major changes in the way the medical world classifies and thinks of “cancer” and the way screening programs are designed.

“This article is really critical for laying the ground work for introducing what I hope will be groundbreaking changes in screening and prevention,” said lead author Dr. Laura Esserman, director of the breast care center at UC San Francisco. Continue reading