Whitewater woman objects to mammogram required to upgrade insurance policy
Whitewater resident N.J. Fulmer doesn’t have a history of breast cancer in her family.
The longtime member of Rocky Mountain Health Plans was offered the opportunity to upgrade her policy and enjoy lower premiums.
While Fulmer would love to sign up, she won’t take that step as long as one of the conditions requires her to have had a mammogram in the past 12 months. Fulmer said she had the test 14 months ago, and it showed no abnormalities when she applied for the health care insurance plan upgrade. She opposes being tested again so soon because of the radiation associated with the test.
“I don’t think it’s right to force such an invasive procedure on women,” said Fulmer, 61. “I can see if my mother had breast cancer, but I don’t have a history of breast cancer. I don’t know if I should be subjected to that.”
Fulmer said she initially was rejected in writing from entering into the new plan because she refused to get a mammogram.
Among other benefits of the new plan would be a $70 reduction in her premium.
Fulmer said she did not have concerns with two other requirements of entering into the new plan. Those were having a Pap smear and having blood work done. She’s had the former test completed and is scheduled soon to have her blood drawn.
After being questioned about the policy and Fulmer’s case, Rocky Mountain Health Plans said it is taking another look at Fulmer’s case and has extended a request to again review her health records. Company officials cannot discuss customers’ personal medical information with others, but company spokeswoman Kayla Arnesen said denials can result from a red flag in a woman’s medical history preceding the last mammogram.
Fulmer is seeking to move from a plan called Solo Select to Solo View.
Underwriting for the company’s plans for women requires a mammogram in the past year if abnormalities exist within a person’s medical record. Otherwise, women can choose whether to have a mammogram yearly or every two years, Arnesen said. Any member can request the company take another look at their policies if questions arise, she said.
Arnesen said the company is following new guidelines released by the government in November. Those say women without pre-existing conditions and without a family history of breast cancer may face more danger than necessary from radiation by the tests while receiving yearly mammograms starting at age 40.
The new guidelines conclude that women do not need to undergo a mammogram until age 50, and the tests should be administered every two years. According to the study supported by the U.S. Preventive Services Task Force, mammograms in younger women have a high rate of false positives and can trigger unnecessary biopsies, and the screening can detect cancers that are so tiny they may never cause a woman harm.
However, the American Cancer Society is sticking to its stance that women should be screened yearly beginning at age 40 to save lives, even if the number of lives are relatively few.
“We are following the new guidelines,” Arnesen said. “We do understand (Fulmer’s) concern for radiation exposure. It’s not our intention to prevent people from coming onto the plan. We need to follow the rules of insurance.”
In comparison, Arnesen said, men entering Rocky Mountain Health Plans health care insurance plans who are 50 years or older are required to receive an annual physical. They are not required to have screens to detect certain kinds of cancers, but if done correctly, those physicals should reveal whether pre-existing conditions exist.
Insurance policies for women and men through the company are constructed according to guidelines from the U.S. Preventive Services Task Force, Arnesen said.
Customers of individual plans are subject to some tests to determine whether pre-existing conditions exist, but those tests aren’t required for customers of group plans. Customers under group plans are considered a single entity.
Fulmer said she is a vocal proponent for reforming health care, often writing letters and e-mails to political representatives, protesting the high costs of insurance and that health insurance companies can charge patients more if they have pre-existing conditions.
“Right now is just a good time to open the discussion about health care,” she said. “Maybe this will open the door to other things.”