Quick Take
Lida Berliner recently learned that Dignity Health Advanced Imaging is not billing insurance for ultrasounds for women with dense breast tissue and she is “outraged.” She had an ultrasound last year, before Dignity bought Dominican Breast Center, and her insurance was billed. Now, she has to pay out of pocket for the ultrasound or wait for second and third mammograms, a process she describes as “painful” and “boob-smashing.” Approximately 50% of American women have dense breast tissue. Here, she questions who is making our health care decisions locally and urges women to find out what their coverage entails. “You can bet if men had breasts, this would not be happening,” she writes.
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I was raised by two medical doctors, so I’ve always understood checkups, vaccinations and the importance of preventative medical care. I grew up respecting science and medicine.
That’s why I am baffled by new insurance policies around reimbursing breast imaging. I just learned that at least some facilities in Santa Cruz County, including Dignity Health Advanced Imaging (DHAI), are not billing insurance for medically advised ultrasounds for women who, like me, have dense breast tissue.
I’m outraged about this. I believe the policy puts women at risk.
Approximately 50% of women in the U.S. have dense breast tissue and among them, 10% have extremely dense breast tissue. The dense tissue makes it harder for radiologists to spot cancer. Getting an ultrasound is simple and painless, unlike mammograms, which are uncomfortable and take a long time to schedule.
I blame the blithe corporatization of our health care facilities that inadvertently and indirectly forces women to wait months for lifesaving screenings.
You can bet if men had breasts, this would not be happening. Men would not put up with waiting so long for tests and having their penises and testicles squashed in a big hunking machine. They would outright refuse.
I learned about this recently – as I tried to do what doctors have recommended women do starting at age 40, get a yearly mammogram. Breast cancer is on the rise in younger women, and mammograms are essential for early detection.
Unfortunately for me, I have dense breast tissue, so for all the years I’ve been getting mammograms, I would frequently have radiologists calling me back multiple times.
How I learned DHAI is not billing insurance for ultrasounds
For me, getting mammograms is miserable.
I know I’m not alone feeling this way. Any woman who’s had a mammogram can attest to the discomfort of boob-smashing. It’s not pleasant to have your sensitive parts squeezed and flattened. So, when one is told to do it multiple times, it becomes onerous, and not something one ever gets used to.
In the past couple of years, my gynecologist has ordered a breast ultrasound in tandem with a mammogram.
Last year, for the first time, I had both a bilateral breast ultrasound, or whole-breast ultrasound, and a mammogram at the same time. And, for the first time ever, I wasn’t asked to come back for multiple mammograms.
It took more time, yes, about 30 minutes, but it’s a lot better than getting one’s boobs smashed multiple times, in a big awful machine over many days.
This year, when I arrived at Dominican Breast Center (DBC) to have the procedure, I learned that DBC won’t bill insurance for the breast ultrasound, so if I wanted to still get it, a desk attendant told me, I’d have to pay $200 out of pocket.
I was confused. Why would I pay out of pocket for a screening that is and was fully covered by my insurance, and got billed to my insurance by this same facility last year? Why didn’t anyone tell me about a policy change?
A few days later, DBC called to say my mammogram was “abnormal” and asked me back for a mammogram redo. I imagined it was because of my dense breast tissue. But I didn’t know for sure.
When they call you back, they never say why. They never it’s because the antiquated monster mammogram machine can’t properly read dense breast tissue. They just say the test was “abnormal,” like there is something wrong with you. This is disconcerting and causes me unnecessary stress every year.
My breast is not “abnormal” – the radiologist just can’t conclusively read the scan because of my dense breast tissue. That leaves me – and other women with dense breast tissue – uncertain, every time.
It’s unnecessary distress I blame on a callous system.
Frustrated, I called Palo Alto Medical Foundation (PAMF) in Santa Cruz, the only other facility I know where I can get an ultrasound, to make an appointment for both a pelvic ultrasound (lucky me) and the whole-breast ultrasound.
Scheduling the pelvic ultrasound was fast, but the breast ultrasound was three months out. Huh?
What if I actually had cancer? Instead of it being nipped in the bud, I’d be dying from cancer if I was forced to wait three months to get these life- saving screenings. Thank goodness I’m retired and have the time to take a deep dive into what I was beginning to realize is a huge mess regarding my own health care, and the health care facilities in Santa Cruz.
How many Santa Cruz County women are waiting too long for preventative health screenings?
DBC was recently sold to Dignity Health Advanced Imaging (DHAI), and along with the rebrand, Dignity, the office staffer told me, doesn’t cover the ultrasound. She apologized that I hadn’t been informed. Staff, she said, aren’t all aware of the many changes that occurred amid the corporate changes.
She was kind enough to try to schedule my redo, but unfortunately, she couldn’t get me an appointment for a month. I asked her why I had to wait so long for just the mammogram redo. She told me that not only was DBC affected by the sale to DHAI, but there was also a staffing shortage at the medical center in Watsonville and many Watsonville patients had to come to Santa Cruz. She also told me that Dominican, now called DHAI, is losing radiologists because of retirement or radiologists moving out of Santa Cruz.
I told her I thought the whole thing sounded like a huge mess, and she agreed.
Why I’m so steamed – and you should be, too
She told me that not only was it more of a hassle for women like me who have private health insurance, but that women on Medicaid with dense breast tissue have always had a difficult time getting appropriate screenings. Even before the changes, women with dense breast tissue on Medicaid are forced to get the mammogram on one day, then wait for a separate ultrasound appointment. For me with private health insurance, I got both screenings together.
The office manager told me there was absolutely no medical reason for the women on Medicaid to be forced to do their screenings that way. Seems like a way to make life even more difficult for low-income people to access care.
Then I went to a supervisor, who told me DHAI stopped billing insurance for breast ultrasounds because the diagnostic/screening was considered experimental and still being researched.
Wow. That really steamed me! Who is deciding this?
“There’s no way a woman would do this to other women,” I said to the supervisor. “These must be corporate decisions made by men!”
The supervisor said she wondered that, too, but couldn’t tell me for certain, so she asked her boss to call me.
That is how I learned more than I ever wanted to know about the difference between screenings and diagnostics, how health insurance companies, in cahoots with the corporate side of health care providers, obfuscate and create opaqueness, so people like me can’t immediately find out why I’m being denied the critical screenings and diagnostics necessary to keep me healthy and alive.
It’s on the shoulders of our physicians to wrangle this odious system, in order to make it work for us patients. Patients have no idea about these shenanigans and bureaucratic technobabble that are formidable walls put up to deliberately make things difficult regarding women’s health care, so facilities don’t have to deal with it, and so insurance companies don’t have to pay for screenings and diagnostics for women with dense breast tissue.
Of course, all that bureaucratic obfuscation is outrageous because it’s obvious that if women knew how health insurance, along with these facilities, are doing everything they can so they don’t have to cover or pay for these lifesaving screenings and diagnostics, women would be royally and duly pissed off.
I also learned about legislation that’s trying to mandate all private, state and federal health insurance providers cover all diagnostics and screenings for dense breast tissue. Katie Couric, who has dense breast tissue, is involved and struggling with breast cancer that could have been diagnosed sooner. She is working to push legislation, the “Find it Early Act,” to make sure these tests get covered.
All the women I spoke with from DBC and DHAI were all aware that I was writing this op-ed, but all said they could lose their jobs if the corporate side knew they were providing me with this information.
Like I said earlier, having dense breast tissue is no fun. The mammogram tech had to do my right breast mammogram three times. Ugh! The pelvic ultrasound is a nightmare because one must have a full bladder first. Get an external ultrasound, then run to the bathroom, then come back for the internal ultrasound. Ugh, again!
These screenings and diagnostics are tough enough for women. We don’t also need to be subjected to ill-advised health decisions by faceless health care bureaucrats.
Men absolutely wouldn’t put up with the archaic and anachronistic screenings and diagnostics, nor would they tolerate all the bureaucratic shenanigans.
I hope women reading this get angry and demand improvements to this absurd system.
Lida Berliner, a retired Santa Cruz resident, is mad that she and other Santa Cruz women with dense breast tissue are getting the shaft from local health care facilities, along with private, state, and federally funded health insurance. Lida hopes her op-ed will motivate Santa Cuz women to rise up and demand overdue upgrades and improvements to life-saving, critically needed health care screenings and diagnostics that save women’s lives.