The term “suspicious findings,” is enough to send women who have had a mammogram into an anxiety attack. It may seem unfortunate for me that I’ve been through this at least three times, but it’s given me valuable knowledge and experience in advocating for my health care. And I believe what I’ve learned can help other women and men do that, too.
After my annual mammogram in April, I was referred to a more comprehensive diagnostic mammogram and then to a surgeon for a surgical biopsy.
I wasn’t convinced I needed a surgical biopsy, having seen a very similar picture on my mammogram twice before that was biopsied by a needle. Surgical biopsies are open surgeries, while a needle biopsy is less invasive. My research indicated that calcifications might continue to grow in my body for the rest of my life with little threat to my health.
Weighing the Costs
A surgical biopsy would have cost my husband and me at least $4,000 out of pocket, given our high deductible and co-pay through my husband’s employer-sponsored health plan. The fee for the outpatient operating room alone was $6,900. That doesn’t add in the surgeon’s fee, the anesthesiologist, the pathologist’s report and any additional hospital fees.
I wasn’t afraid to seek a second opinion through another hospital system. The larger system, about 15 minutes further, accepted our insurance, and I confirmed our plan does allow for second opinions.
The second surgeon, who had been exclusively a breast cancer surgeon for 20 years, said he didn’t feel it was anything to be concerned about. Nevertheless, he decided to consult his radiology department for their opinion.
An Even Bigger Savings
They agreed a needle biopsy would suffice. Our out-of-pocket expenses would still be about $1,200. When I went for the needle biopsy, the radiologist entered the room saying he only thought there was a 5 percent chance of it being cancer. When I told him the out-of-pocket cost for this procedure, we discussed taking a wait and see approach, which he said would neither make the condition worse or change my treatment options if it turned out to be cancer.
After undergoing another diagnostic mammogram, which showed no change after three months in the “piece of rice” (as I like to call it), I decided to pocket my $1,200 and wait and see.
Knowing What to Question
“I can’t tell you how many times I hear this happening from patients,” says Dr. Paula Muto, a vascular surgeon and founder of UBERDOC, an app that allows member patients access to specialists. “Doctors will always be conservative, fearing a lawsuit if they miss cancer or other serious illness.”
Muto says I did the right thing by doing my research, seeking a second opinion and asking what would happen if I waited.
“More doctors should be looking at the bigger picture, trusting their instincts and telling patients what would happen if they take a wait and see approach,” Muto says. “Especially now that insurance is shifting more costs to the patient.”
John Gallagher of the Washington Health Alliance in Seattle cites a shocking statistic from the 2011 Dartmouth Institute for Health Policy and Clinical Practice study: Up to 30 percent of Medicare clinical care spending is “unnecessary or harmful and could be avoided without worsening health outcomes.”
The Alliance partners with the Choosing Wisely Campaign, an initiative of the ABIM Foundation (American Board of Internal Medicine) and Consumer Reports to help patients start a dialogue with their doctors about avoiding unnecessary tests, treatments and procedures.
Smart Questions to Ask
Gallagher says the Alliance recommends patients ask these questions when they are referred for tests and procedures:
Do I really need this test or procedure?
Ask your doctor to tell you if you really need the treatment, test or procedure and how it will make a difference.
What are the downsides?
Your doctor should clearly outline the risks of the treatment, test or procedure so that you can balance them with the potential benefits.
Are there simpler, safer options?
You should know all your choices to determine the right one for you.
What happens if I do nothing?
Sometimes, doing nothing can be an option to consider seriously.
How much does it cost?
Consider your out-of-pocket costs. A simpler treatment may cost less money and be just as effective.
More Cost-Saving Measures
Additionally, Gallagher says you can do other things to avoid skyrocketing out-of-pocket expenses.
“One of the most basic things is not to use the ER unless it is really an emergency,” he says. “Most people go for things such as UTIs, back pain, pink eye and respiratory infections, when those things could be taken care of in an urgent care clinic.”
Gallagher also says if you and your doctor agree to a procedure, don’t let medical professionals determine where you will get your care. Instead, do a little research and you might save some money.
“If you need a colonoscopy and your doctor refers you to a hospital, there could be a facility fee. If there is a diagnostic center, it’s typically less expensive,” says Gallagher.
If you have an employer-sponsored health plan, you might be able to compare costs of one facility over another by using the cost calculators. “Most plans have them and most are underutilized because people don’t know they exist,” says Gallagher.
Finally, Gallagher says the old adage that an ounce of prevention is worth a pound of cure holds true. He said people should be having wellness exams, especially if they have pre-existing conditions such as diabetes and other chronic ailments.
“Things are a lot less expensive and typically are a lot less grief if [they] are monitored and taken care of early rather than being allowed to develop into a problem,” he says.
Be Confident in Your Doctors and Your Decisions
Would my decision to wait and see be right for everyone? Probably not, but given my history and confidence in my second medical team, it was right for me.
The trick is doing research, understanding your body and medical history and knowing which questions to ask of your health care professional. That way, you can make the choice that’s best for you, your health and your peace of mind.
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