Mammogram costs: A New York-California comparison

Summary: Insurer payments for mammograms in California seem to be higher than they are in New York, according to preliminary results from our PriceCheck crowdsourcing project with KQED public radio in San Francisco and KPCC/Southern California Public Radio in Los Angeles.

 

 


 

California insurers paid prices ranging from $134.41 to $1,200, according to our data, with a bulge around $500-$700.

In New York, where we did a similar project in summer 2013 with WNYC public radio, we saw a big bulge around $450, and not that many higher than that. We’re still collecting data in California, and haven’t made a chart yet. But for comparison’s purposes, here’s what we found from New York data.

The mammogram pricing project: Charged price vs. negotiated price.
The mammogram pricing project: Charged price vs. negotiated price.

We’ll be doing a chart like this with our California data once we get a little further down the road.

But! California, you’re winning the no-copay prize, so far.

In our WNYC experience, nearly a quarter of the respondents were paying something out of pocket for mammograms — either because they were uninsured, they were choosing to go out of network, they were told they hadn’t met their deductible or they paid a bill they felt was sent in error. That data was collected last year, when the Affordable Care Act was not fully in force, so some plans were probably not obligated yet to deliver free mammograms.

But now, in California, we are not hearing from very many women who are being asked to pay for their mammograms. That’s good, since that was one of the stipulations of the A.C.A., that preventive care like mammograms and colonoscopies should be fully covered.

It seems that the women who are being asked to pay are having diagnostic mammograms, where a lump or pain or family history suggests the procedure is seeking a diagnosis, while preventive mammograms — the regular screening mammograms that are not seeking a diagnosis — are, at least so far, free.

 

 


The chart above was part of our WNYC “price of a mammogram” series. Other posts are here.

1. Where’s my free mammogram?

2. The overview: How much does a mammogram cost? Prices, payments vary widely, our survey with WNYC finds.

3. We don’t offer medical advice, but we wanted to tell you about the guidelines. When is a mammogram not a mammogram?

4. How much does a mammogram cost? Your tales of bills: $0 to $2,786.95.

5. Women’s health resources. No one should ever have to go without a mammogram or other women’s health issues. Reproductive health belongs to us. Here are some resources, and some thoughts about women’s health.

6. Acts of healing, and of overcharging: Contributors talk about their mammograms.

7. How much does a mammogram cost? The takeaway.

8. How should you choose a mammogram facility? Dr. Geraldine McGinty explains.