SAN ANTONIO – House Bill 195, which was filed in the Texas Legislature, aims to eliminate the disparity in health insurance coverage between screening and diagnostic mammograms.
More than three years ago, Lisa Kerkez was diagnosed with breast cancer and an aortic aneurysm.
"The financial burden of it was overwhelming," Kerkez said. "To me, my priority was staying focused on getting well and getting prepared for what was, you know, to follow."
Kerkez's fight with the disease that is expected to claim the lives of more than 40,000 women this year in this U.S. isn't over. She's now an advocate for HB 195, which is authored by state Rep. Diego Bernal, so other Texans won't have to pay costly out-of-pocket expenses for diagnostic mammograms.
"The insurance that I had did not cover the diagnostic. It was not part of the routine mammogram," Kerkez said.
Currently, the Texas Insurance Code requires coverage for an annual screening by low-dose mammography.
Under the Affordable Care Act, health plans offer preventive screenings, including regular mammograms, at no cost to patients. If something is detected or additional testing is required, patient cost-sharing, such as co-pays and deductibles, would apply and vary depending on the insurance plan, according to an email from a Texas Department of Insurance spokesman.
Consumers need to look at their health plan’s summary of benefits and coverage to see what cost-sharing applies to.
"If they need additional pictures to be able to diagnose them with breast cancer, it really makes sense that these women are able to access that care," UT Health medical oncologist Kate Lathrop said. "It doesn't make sense to give them access to the first half and not the second half."
"I put together four different fundraisers to allow me to live and buy my meds," Kerkez said.
The breast cancer survivor said she has never qualified for any sort of financial assistance and continues selling Fiesta medals to pay medical bills. She's also received help from nonprofit WINGS.
"Let's pray and stick together and let's get this House bill passed for future patients who will be diagnosed with breast cancer," Kerkez said.
Kerkez said she was a member of Humana when she was diagnosed with breast cancer. A Humana spokesman sent the following statement via email:
Protecting our current or former members’ privacy is an important priority for Humana, and federal and state privacy laws prevent us from commenting on particular circumstances involving our members.
Humana strongly believes that an annual mammogram is extremely important to the health of women. It can detect cancer in its early stages when it is most treatable and can save lives. Humana members are eligible for screening and medically necessary diagnostic mammograms per the USPSTF (United States Preventive Services Task Force) guidelines or state mandates. A screening mammogram would not be denied by Humana unless that request would be outside the coverage guidelines as outlined in our policy.
Bernal told KSAT that even if HB 195 passes, there's no way it could require every health insurance plan to cover diagnostic mammograms. However, he believes it's a start, and early detection of breast cancer saves lives. Bernal has lost an aunt to breast cancer.
Susan G. Komen San Antonio also provided a community profile that identifies priority areas based on demographic information, input from neighborhood focus groups and the medical community.