Patients could face hundreds of dollars in costs for follow-up tests after free cancer screening

Eleven years ago this month, the scans and exams that hold the most power for detecting the first signs of cancer became available free to many American adults.

Now, two new studies show that when these screening tests reveal potentially troubling signs, patients could face hundreds of dollars in costs for follow-up tests.

The studies, led by teams at the University of Michigan and Duke University, could inform efforts to ensure patients follow abnormal test results and don’t delay care because of cost. Such delays could lead to the cancer going undiagnosed and progressing, which could lead to worse patient outcomes and high medical costs.

The studies look at out-of-pocket fees charged to older people who have had CT scans for lung cancer, and to women after a Pap test or abnormal cervical exam.

The first article, led by radiologists Tina Tailor, MD, of Duke and Ruth Carlos, MD, MS of UM’s Michigan Medicine, examines what patients were charged for lung biopsies and other invasive procedures used to track a CT scan. abnormal lung. . It is published in the Journal of the American College of Radiology.

A total of 7.4% of patients who underwent a lung cancer screening scan underwent at least one invasive follow-up procedure. While 20% of this group have been diagnosed with lung cancer, the rate of interventions “downstream” from the screening scanner is higher than what has been observed in clinical trials of this type of screening. Such studies established the value of lung scan screening in some older people and led to free access in 2013.

More than half of the patients who had surgery after their lung scans were asked to pay something, sometimes hundreds or even thousands of dollars out of their own pockets. Forty percent paid nothing for their follow-up care.

Now that more U.S. adults are eligible for free lung cancer screening, due to new evidence on its ability to detect the disease at an early stage, the authors say insurers may be looking at ways to reduce the financial burden on people. people with abnormal tests and requiring follow-up care. to determine if cancer is present.

The second article, published in the journal Obstetrics and Gynecology by a team led by UM Professor of Internal Medicine A. Mark Fendrick, MD, and Assistant Professor OB-GYN Michelle Moniz, MD, M.Sc., examine what women paid out of pocket for a type of cervical exam called a colposcopy. Carried out after a smear, HPV test, or routine cervical exam gives abnormal results, a colposcopy may include a biopsy or other procedures.

Women who had colposcopy without further procedures paid an average of $ 112, while those who had cells taken for further examination paid an average of $ 155. Those who underwent other procedures faced hundreds of dollars more in costs – and this direct cost has risen sharply over the 13 years studied. By 2019, a woman who received additional care beyond a biopsy could expect to face a total bill of almost $ 1,000.

Costs much lower than these have been shown to prevent women from getting recommended health care, ”said Moniz. “It is therefore high time to consider removing the financial barriers to recommended cancer prevention care.

Michelle Moniz, MD, M.Sc., Assistant Professor OB-GYN

“The Affordable Care Act requires improved preventive care coverage for more than 150 million Americans, including initial screening tests for breast, cervical, colorectal and lung cancer.” said Fendrick. “Since screening for these cancers often requires multiple steps, health insurers should remove barriers that can create financial hardship or deter a person from completing the screening process. “

Carlos, Fendrick and Moniz are members of the UM Institute for Healthcare Policy and Innovation. Fendrick heads the Center for Value-Based Insurance Design.


Michigan Medicine – University of Michigan

Journal reference:

Fendrick, AM, et al. (2021) Reimbursable expenses for colposcopy in commercially insured women from 2006 to 2019. Obstetrics and Gynecology.

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