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Missing pieces: Why many employees still worry about paying for their own cancer screenings

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Given that they are preventive, cancer screenings seem like the type of thing that would be fully covered by health insurance, especially if you’re employed. Even for fully-insured individuals, that is not always the case. Here are some reasons why people still worry about paying for cancer screenings, even though screenings are typically free under the Affordable Care Act.

1. Screenings are meant for asymptomatic individuals, but some insurance plans don’t always see it that way.

Under some plans, individuals must show symptoms before the health insurance plan will cover cancer screenings. The logic is backward, given that cancer screenings are meant for populations of asymptomatic individuals. Here’s what The American Cancer Society says about screenings:

Screening tests are used to find cancer before a person has any symptoms. Screening can often help find and treat pre-cancers and cancers early, before they have a chance to spread.

Nevertheless, many asymptomatic individuals are left out of the fold, or told by insurers that they’ll have to pay on their own. This situation is especially problematic for younger individuals who have an increased risk for cancer (due to family history, occupational influences, lifestyle, etc.), but don’t yet know it.

For example, firefighters who face occupational risk for lung cancer might not have cancer screenings paid for by their city health care plan. This is the case for firefighters in Williamsport, PA, who have resorted to fundraising efforts in order to fill the void left by their insurance plans. The fundraising effort is intended to help current and retired firefighters access screenings years before insurance coverage would foot the bill—and years before a late-stage cancer diagnosis comes about too late. Read more about this story from ABC Newswatch 16.

2. People with an increased risk for cancer are sometimes asked to pay more than usual.

Under some insurance plans, cancer “screenings” are categorized differently from cancer “surveillance.” In context, this often means that people who are recommended by doctors to “surveil” cancer by being regularly screened are charged different dollar amounts than people who go into screenings with no risk profile.

Just this year, the distinction left one patient in Missouri with a $12,000 bill for a routine colonoscopy. Once the patient was determined to have an increased risk for colorectal cancer, her insurance company started to bill her colonoscopies as surveillance procedures, rather than no-cost screenings. Even though the colonoscopies were recommended to further prevent colorectal cancer in the future, they came at a cost. Read more about this story in STAT. 

3. Cancer screenings are caught in the fray of political divide.

The Affordable Care Act has made dramatic inroads to decrease the number of people who are uninsured in the U.S. Additionally, the elimination of cost-sharing for preventive services that came with the ACA has helped to increase uptake of cancer screenings like colonoscopies and mammograms.

This year, however, a federal judge struck down the provisions of the ACA that require insurers provide certain preventive care services for free. The ruling was primarily focused around access to PrEP, but affected preventive services like cancer screenings.

Divide around ACA — which has successfully propelled 10 states to get uninsured rates down to 5% — is emblematic of how a race toward universal coverage does not always yield universal access. If the judge’s ruling against ACA stands, free preventive cancer screenings for everyone may fall out of grasp. 

For employers, cancer screening and prevention programs can greatly reduce the financial impact of late-stage cancer. When employees have the benefit of fully-covered preventive screenings, they are likely to stay ahead of costly cancer diagnoses.