A woman from Washington state, Stephanie Halver, found out that breast MRIs aren’t always covered as zero-cost preventive care like mammograms are.
Last year, her primary care doctor used a risk assessment tool to gauge her likelihood of developing breast cancer, and Halver, now 43, remembered that her score was quite high. This was partly due to her family history—her mother and aunt had both battled breast cancer—and also because her dense breast tissue increases her risk. Living in Vancouver, Washington, Halver’s doctor suggested she get an annual breast MRI, six months after her yearly mammogram, as a precautionary measure since MRIs can catch issues that mammograms might overlook.
For example, actress Olivia Munn had a breast MRI in 2023 that identified an aggressive cancer type in both breasts, even after a recent mammogram appeared clear. Munn’s doctor recommended the MRI after a risk assessment indicated that she had an above-average chance of developing breast cancer, similar to Halver’s situation.
Early detection of breast cancer, before it spreads, significantly boosts survival rates, according to the National Cancer Institute. After getting preapproval from her insurer, Halver booked her MRI for September. Fortunately, the MRI didn’t reveal any problems. But then the bill arrived.
The Medical Service
A breast MRI, which stands for magnetic resonance imaging, provides a detailed look at breast tissue compared to mammograms. These scans are generally suggested for women at increased risk for breast cancer—like those with dense breast tissue or a family history of the disease—while not typically recommended for women deemed at average risk, as they can sometimes result in false positives and unnecessary follow-ups.
Breast MRIs are also valuable for diagnosing cancer when a mammogram shows abnormal results or to assess the cancer stage after a diagnosis.
The Bill
Halver received a bill of $1,205; after her insurance covered just $13.90, she was left to pay $1,191.10. There was also a $65.60 charge for medication used to keep patients calm during the scan, half of which her insurance covered.
The Billing Problem: Not Always Preventive
Upon receiving the MRI bill from Vancouver Clinic, where the procedure took place on September 26, Halver was baffled. She knew that the Affordable Care Act mandates that health plans must cover preventive care—including Pap smears and mammograms—at no cost.
Halver’s breast MRI had been recommended by her doctor and preapproved by Blue Cross Blue Shield of Texas, her employer-sponsored plan. Since the purpose of the MRI was preventive, she had assumed it would be without charge. Adding to her confusion, Washington state law requires many insurers to cover breast MRIs.
“I’ve had many phone calls trying to understand” this whole situation, Halver mentioned.
Essentially, the U.S. Preventive Services Task Force, which advises the federal government on required screenings, does not classify preventive breast MRIs under their guidelines. They’ve stated that the “current evidence is insufficient to assess the balance of benefits and harms” related to breast MRIs for women with dense tissue and an otherwise normal mammogram.
However, the federal guidelines differ for cases where an abnormality is detected during a mammogram, as noted by Cathy Peters from the American Cancer Society Cancer Action Network. In those instances, additional imaging like ultrasounds and MRIs are classified as preventive according to the federal Health Resources and Services Administration’s guidelines.
This inconsistency can be frustrating. Peters pointed out that women who haven’t had abnormal mammograms might face hefty bills, making them more cautious about future screenings after such an experience. While some states mandate coverage for breast MRIs, those laws often don’t help women like Halver, as large employer-sponsored plans fall under federal regulation instead.
The Resolution
Blue Cross Blue Shield of Texas did not respond to inquiries regarding Halver’s benefits or the bill. After appealing the insurer’s decision, she received a letter in July denying her appeal.
Halver discovered via her employer’s HR department that mammograms were covered as preventive screenings in her health plan, but breast MRIs were not. This meant her annual MRI would be subject to deductibles, coinsurance, and various costs. Her analysis of the situation indicated that her breast MRI would apply to her $3,300 annual deductible.
“I think I’m on the hook for this bill,” she admitted, adding that, given her high risk of breast cancer, “that’s a guaranteed bill every year.”
The Takeaway
If your medical provider suggests an annual breast MRI along with your yearly mammogram, it’s wise to look into your state’s coverage laws. The DenseBreast-Info website provides a helpful map with updated information about state laws concerning breast cancer screenings, and depending on your location and insurance plan, preventive MRIs might be fully covered.
In case you end up facing a significant bill, there are steps you can take to potentially reduce your costs. For instance, Ricki Fairley, co-founder of Touch, the Black Breast Cancer Alliance, advised finding a patient navigator at your hospital or cancer center to help you.
She also encouraged women to explore community resources or national advocacy groups—like Touch—offering support to offset breast cancer screening costs for low-income patients. Furthermore, comparing prices from various providers can be beneficial, as freestanding imaging centers may have lower rates than hospitals. If you can, scheduling the MRI at the end of your deductible year could also help minimize out-of-pocket expenses if you’ve already met your deductible.
