Medford woman can't get mammogram through OHP locally

MEDFORD, Ore. — “Its should just be like a standard we’re all able to have is a mammogram,” said Michelle Paul, a Medford resident.

Paul got on the Oregon Health Plan this summer through Jackson Care Connect following her husband’s death.

She’s now 4 months overdue for a mammogram and it’s not by choice.

All of the hospitals in the Rogue Valley have switched from 2D to 3D imaging for mammograms.

Paul was shocked to discover that because the Oregon Health Plan doesn’t cover 3D mammograms, she can’t get a mammogram locally through OHP.

“I was just ready to give up,” she said. “I thought well, I’ll wait maybe 6 months to call back and see if they’ve changed their policy or if they found someone within fifty miles. You can’t even go fifty miles to get one she said maybe Eugene, you could drive there.”

We reached out to Providence Medford Medical Center to learn more about the new technology.

“I have found breast cancers through those scans,” said Nicole McPheeters, a supervisor at Providence Medford Medical Center’s Breast Center. “Just from a technologist standpoint… at much earlier points than we would have ever previously.”

McPheeters has been performing mammograms, breast ultrasounds, and biopsies for 17 years. She says the new 3D imaging helps them detect invasive breast cancers 20 to 60 percent better than 2D.

In some cases, she says that can mean the difference between life and death.

“1 in 8 women will be diagnosed with breast cancer and those are strong statistics,” she said. “And even patients without family history, statistically they’ll say 9 out of 10 women didn’t have family history.”

McPheeters told us most private insurances cover the full cost of 3D mammograms. Out of pocket, she says it can cost between $350 to $400.

That includes having a radiologist interpret the results.

“It is the standard of care and that is the standpoint for this valley,” she said. “The radiologists felt very strongly and so did both hospitals. Us doing a 2D on a patient at this point would be doing them a disservice.”

But that’s not what Jackson Care Connect told NBC5 News.

“There are no studies that show clinical outcomes over regular mammograms and the expense is much higher than a regular mammogram and in some cases it increases it by 40 percent,” said the CEO of Jackson Care Connect, Jennifer Lind.

Lind says her organization follows the guidance of the Oregon Health Plan.

She says OHP has its own “Health Evidence Review Committee” which has met on multiple occasions to consider covering 3D mammograms.

It’s always opted not to, and that decision doesn’t appear likely to change anytime soon.

“Not unless there are clinical studies showing different evidence,” she said.

NBC5 News asked Jackson Care Connect what people should do if they can’t find a place to get a 2D mammogram. The company says sometimes they do cover out of network or services outside the OHP benefit, but it depends on specific cases.