Diagnostic Dilemma: East Texas woman raises awareness on bills protecting breast cancer coverage

“It is so important to file a claim if you are not getting the benefits that you are allowed.”
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Published: Mar. 23, 2023 at 4:23 PM CDT|Updated: Mar. 23, 2023 at 10:33 PM CDT
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TYLER, Texas (KLTV) - After going through a procedure to check for breast cancer, an East Texas woman is surprised to find a bill asking her to pay for something that, by state law, is supposed to be covered by insurance.

Liz Rimler has had to get multiple diagnostic mammograms, a test used to check for breast cancer after a doctor finds a lump or sign of the disease.

She got a diagnostic mammogram in 2017 and paid hundreds of dollars for it out of pocket. When she found out this September that she would need another diagnostic mammogram, she researched how she can get help covering this cost.

“The diagnostic mammogram took place in October which is breast cancer awareness month,” Rimler said.

In her research, she found House Bill 170. The bill passed in 2019 to ensure insurance covers mammography costs under certain health benefit plans.

“When I talk to other women about this, I didn’t know and I discovered that women I talked to didn’t know either,” Rimler said.

She said she then talked to her doctor and insurance company about the bill. “But sure enough, I received a bill after the procedure was done, and so there seems to be some confusion,” Rimler said.

“Insurance companies said the wording was murky enough in House Bill 170 that they didn’t have to cover the ultrasound and MRI that went with the diagnostic mammogram,” Rimler said.

Senate Bill 1065 adds specific wording including “diagnostic mammogram” and “other breast imaging” to protect the cost of more screenings.

State Representative Dieo Bernal is the author of House Bill 170. He also helped pass Senate Bill 1065.

“So we had to make sure that every machine, every procedure was covered, so regardless of where you are in the state if you’re on Medicaid or if you’ve got one of those state controlled insurance plans, you can get the help you need so 1065 was designed to just close all those gaps,” Bernal said.

“It obviously can’t do everything. There’s still limits to the amount of authority we have, there’s limits to the amount of authority the state has, we need a system that ensures that everyone has access to the lifesaving care that they need,” Bernal said.

When it comes to breast cancer, “The early detection of breast cancer makes it much more likely to be cured,” Dr. Arielle Lee said. “The mammograms are a wonderful tool we’ve had to help us with early detection so then that gives us the chance to cure breast cancer.”

For Rimler, the chance to cure is close to her heart. “My grandmother died of breast cancer and in many families and many people I know this is an effect that can change the lives of myself and those around me.”

Rimler got the procedure in October. “Luckily, my diagnosis is fine. At the diagnostic mammogram, the findings were all clear, and so luckily I don’t have my health to worry about on top of this.”

For months, she made calls back and forth between her doctors, the insurance company, and the Department of Insurance. “They seem to blame each facility for not billing correctly and when I talk to the facilities of course they say they can only cover what insurance says they will cover,” Rimler said.

“It seems very clear to me when you look at the way the legislature is written that women should not have to pay for this and so it’s really been confusing to me that what are we even arguing about it all seems very clear to me,” Rimler said.

After researching, “I had not paid that bill because I knew for certain that that is not a bill I owed,” Rimler said. “I was afraid to go ahead and pay it because then I thought the process of trying to get that reimbursed would be a lot more difficult.”

Rimler filed a claim with the Department of Insurance at the end of January.

“It is so important to file a claim if you are not getting the benefits that you are allowed,” Rimler said.

On February 28th, she called to follow up with the DOI. “Through their investigation they discovered that yes they were missing out on covering this expense that was supposed to be covered,” Rimler said. “The Department of Insurance uploaded a letter from Blue Cross Blue Shields stating that they were going to cover at 100% because they did their research and discovered that they should have been covering that all along.”

After going through this diagnostic dilemma, “I hope that all women will raise their voices and figure out what we need to do to draw attention to this issue so that it’s taken care of as our legislators wrote it for us,” Rimler said. “We need to all fight to get what we deserve that our legislators worked so hard to put these fair bills in place for us.”

Rep. Bernal said Bill 1065 is only the beginning. “I’m really happy that it passed, I’m proud that it passed, but if we’re being honest, it’s one step in a much longer effort and conversation because there is so much more to go.”