Investigation prompts change to state mammogram policy

Print
Email
|

by JESSE JONES / KING 5 News

Bio | Email | Follow: @getjesse

KING5.com

Posted on July 19, 2013 at 5:31 PM

Updated Thursday, Jan 2 at 8:46 PM

SEATTLE -- A Get Jesse investigation has brought big insurance changes for those under the state employees plan. The Health Care Authority will now cover screening mammograms for women under 40 who are at high risk of breast cancer. 

This all started when a Ballard woman who was upset with the system decided to call me. 

"I'm still processing it. It's neat," expressed Joy Griffith.

Griffith had no idea the initial denial of her screening mammogram would lead to coverage for thousands of others.

"It's been quite the big endeavor.  More than I ever thought," expressed Griffith.

Thirty-six-year-old Griffith is at high risk of getting breast cancer because her mother was diagnosed with the disease at age 46.  But when she went to Swedish to get a mammogram that was approved by her health care provider, she learned it wasn't covered by her insurance.

"It was an uphill battle. It felt like no one was really hearing me.  And they'd point me in a different direction.  I was really frustrated.  After several phone calls I realized this wasn't going to be easy," recalled Griffith.

Because Joy's husband works for the state she's covered under the Uniform Medical Plan. It's the state's health plan and is the most popular. But at the time it did not cover screening mammograms for women under 40.

"There was probably other women who were up against this the same as I am.  And they either didn't have the resources or the time to keep fighting for what was right and that's something that hit me," said Griffith.

After the denial, the mother of two called me and I contacted Dr. Daniel Lessler, Chief Medical Officer for the UMP.  A few weeks later he had had great news.

"We reviewed the policy, reviewed the evidence and updated the policy.  Going forward, women under 40 who are high risk, UMP now does cover screening mammograms," said Dr. Lessler.

Next week, UMP is sending out 17,000 notices to its female subscribers.  It explains that those with risk factors that include a mother, sister or daughter with a history of breast cancer or a family history of genetic changes linked to breast or ovarian cancer will have their mammograms covered when ordered by a health care provider.

"It will be very important for them to talk to their primary care provider and explore that history because among some of those women they would be high risk," explained Dr. Lessler.

The change is immediate so women who have those risk factors are encouraged to consult with their primary care providers right away.

As for Joy, she's feeling just that. Not just for now, but for the future.

"My friends say stuff to me like, 'You're changing this for women in the state of Washington to have this insurance.'  It's still something I'm trying to understand it's really neat," exclaimed Griffith.

It’s neat for her and simply perfect for everyone.

Print
Email
|