Her breast MRI was approved, but that didn’t mean her insurance would pay

Key Points:

• Stephanie Halver, a Washington state woman at high risk for breast cancer, was surprised to receive a large bill for a preventive breast MRI, which her insurance did not fully cover despite preapproval and the scan being recommended by her doctor.
• Unlike mammograms, breast MRIs are not universally covered as zero-cost preventive care under the Affordable Care Act, as the U.S. Preventive Services Task Force has not recommended them for women without abnormal mammogram findings.
• State laws in Washington and some other states require insurers to cover breast MRIs, but these laws generally do not apply to large employer-sponsored self-insured plans regulated federally, leaving many patients responsible for significant out-of-pocket costs.
• Experts warn that high out-of-pocket costs for breast MRIs may deter women at increased risk from getting recommended screenings, potentially impacting early cancer detection and survival rates.
• Patients advised to research their state’s breast MRI coverage rules and seek assistance from patient navigators or advocacy groups to help manage costs and access financial support programs.