'It breaks your heart': Oklahoma women paying big prices for breast cancer screenings
OKLAHOMA CITY (KOKH) — Oklahoma women are often saddled with a high bill for necessary breast cancer screenings, despite a new state law to tackle just that. We've got your back, uncovering the loopholes insurance companies are using to avoid paying up and the efforts to force their hand and save more lives.
An annual mammogram for some women is not enough, even when no issues are spotted on that initial screening. Many women will get notified after their mammogram that they are high-risk and need additional screenings, like an MRI. We learned the out-of-pocket cost, even with insurance, can run hundreds, sometimes thousands, of dollars.
"I thought we had solved the problem," said State Senator Jessica Garvin. "We've got to do something about it."
Sen. Garvin, a Republican from Duncan, voted in favor of a new law last year. HB 3504, introduced by State Representative Melissa Provenzano, made Oklahoma one of nine states now requiring insurance to fully cover those additional and necessary screenings for women with a high risk of breast cancer.
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So why are most plans still not paying up?
"Many types of policies are exempt from state laws," said JoAnn Pushkin, executive director of DenseBreast-info. "State-funded plans are exempt. Out-of-state plans are exempt. And federal plans, like Medicare"
According to AHIP.org, 60% of employer-offered insurance plans in Oklahoma are 'self-funded' and are among the plans not bound by Oklahoma state laws. Advocates from DenseBreast-info and Susan G. Komen say a federal law is necessary to make all plans comply.
"It breaks your heart," said Pushkin. "This is screening women need to be here to raise their kids."
Two bipartisan federal bills are expected to be reintroduced on Capitol Hill this year, the Access to Breast Cancer Diagnosis Act, which is also known as the 'ABCD Act' and the Find It Early Act, removing the financial burden of screening for women considered high-risk.
High-risk patients can include breast cancer survivors, those with a family history, or dense breast tissue. Extremely dense tissue can mask cancers in a traditional mammogram. And when those cancers are finally spotted, they are likely far more advanced and deadly.
"I had extremely dense breasts, and my cancer was missed year after year and year, hidden in dense tissue," said Pushkin.
Advocates know getting a federal law across the line won't be easy.
"A lot of the pushback we get on this is from insurance companies that don't want to shoulder the cost that's been passed on to patients," said Molly Guthrie, Vice President of Policy & Advocacy at Susan G. Komen. "But in our opinion, if we are catching cancers earlier, then ultimately there should be cost savings."
Guthrie points out the ultimate goal is saving lives. She says state laws like Oklahoma's are a good start, helping build momentum for potential federal legislation. But there's frustration women here are still falling through the cracks.
With state lawmakers' hands seemingly tied, we asked Sen. Garvin if she feels helpless.
"I'm very stubborn," she answered. "I'm bound and determined to find another option. I don't know what that looks like, but I'm going to continue to research that."
In the meantime, Sen. Garvin says she'll be pushing our U.S. lawmakers to pass legislation and is encouraging other Oklahomans to do the same.
She said, "Women should not have to choose between feeding their family and their general health."
FOX 25 reached out to all of Oklahoma's congressional delegation to find out if they'll support the federal measures to get these screenings fully covered. Senator Markwayne Mullin and Congressmen Tom Cole and Frank Lucas all tell Fox 25 they plan to once again back the ABCD Act, while Senator James Lankford says he won't support any federal measure requiring insurance companies to pay for screenings for women who are considered 'high-risk."
He issued this statement:
Several of my family members and close family friends have suffered from breast cancer, so I certainly understand the importance of screenings. Getting access to early cancer screenings for Oklahomans through their private insurance shouldn’t require an act of Congress, and it doesn’t have to. Most states have mandated coverage requirements for private health insurance companies doing business within their boundaries, which also encourages state and regional competition in the health insurance market to drive down premiums. Federal insurance also has national requirements for coverage on a multitude of screenings.
Reps. Stephanie Bice, Josh Brecheen, and Kevin Hern did not respond to our request by our deadline.
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