Lady parts health issue: help me figure out my plan of action

April 5, 2013 12:41 PM

I need to figure out what to do about an abnormal pap with a lack of comprehensive health insurance.

YANMD. History: In March of 2012, I went in for my first ever pap smear and got back the result moderate dysplasia and a yeast infection, but negative for HPV. I went in for a colposcopy a few weeks later, the gynecologist said she didn't see too much of anything abnormal but biopsied what she saw- "a spot about as big as a pencil eraser." The biopsy came back okay. I was told to come in for another pap in three months. I did not have the money for what my insurance wouldn't cover and didn't go.

This March I went into a different gynecologist after changing health insurance. I just received results of the pap back and they were "ASC-US" (atypical squamus cells of undetermined significance) and HPV test "abnormal." And again, a yeast infection.

I haven't called back yet so I don't yet know what my gynecologist will recommend, I wanted to get some info first BECAUSE.... My health insurance situation is not great. While the pap was covered under the affordable health care act, for any followup care I have a deductible of around ~10k. I make about $1000 a month and while I do have an emergency fund that could cover the followup, I'd like to figure out a little more about my situation and options before I get back to my gynecologist.

Questions:

-What is my timeline here in terms of getting a followup? I don't want to mess around with cancer, but also I don't want to freak out and spend money I don't really have figuring this out RIGHT NOW if it's not necessary. I expect to improve my financial/insurance situation within the next two or so years, and will certainly go in for a pap next March and if necessary fund any follow up out of pocket. Would waiting a year be reckless?

-How much would a follow up pap or colposcopy cost? when I looked at med bills last year it looked like out of pocket it would have cost me about $1000 for the colposcopy and biopsy. Is this standard? Would my gynecologist's office be able to give me the precise cost before I proceeded with followup?

-Any options for getting a follow up cheaper? I am in RI, 25, not a student. I do have (catastrophic) health insurance.

-And a slightly different question-- I have read previous threads where people differed in opinion about this but is the HPV positive thing something I should tell my boyfriend about? I know it's super common but also can cause cancers in guys too, right? My bf has had a death in his close family due to cancer recently and does things like use natural hygiene products, avoid using plastic in cooking, etc due to concern about cancer. Part of me feels like given that situation this is definitely info I shouldn't withhold, part of me feels like it would just cause him unnecessary anxiety (something he is sometimes prone to in other situations).

Thanks for any input!

posted by sockypuppeteer to Health & Fitness (10 answers total)

Not to freak. I would go back to your Gyno and discuss your options with her. Tell her your insurance situation and see what she recommends.

I had a pre-cancerous thing last year and had it lasered off. I have an HSA so that was $4,000 I had to pony up. The total was $14,000, but I had hit my deductable.

Doctors will work with you, hospitals will work with you, if you can jigger your insurance, they'll see how to get around it. There are different rates depending on who is paying, they may have a sliding scale.

When I was making my arrangements, I had a special consultation where they went over EVERYTHING with me. I had some things coming up (travel and whatnot) and asked if we could do it in October, or if it was urgent, she said, "Oh! No worries, whenever it's convenient."

So that's what I did.
posted by Ruthless Bunny at 1:04 PM on April 5, 2013

Planned Parenthood in my area offers services on a sliding scale- free if you are poor enough- and also does colposcopy. If there is one in your area, call them.
posted by charmedimsure at 1:19 PM on April 5, 2013 [7 favorites]

(Sorry, they also do other followup like LEEP, although they refer cone biopsies out- it would be unlikely you would need anything they don't offer, and it's all sliding scale.)
posted by charmedimsure at 1:21 PM on April 5, 2013 [1 favorite]

Yes, you should tell your boyfriend about your HPV status. For one, maybe he has it and doesn't know, and has given it to you, to people before you, and if you two ever part he might give it to others in the future.

Or let's say he doesn't have it. He has the right to control his exposure to it, which he cannot do if he doesn't know.
posted by Houstonian at 1:49 PM on April 5, 2013

Response by poster: IMPORTANT UPDATE: I just checked the papers they sent me again and I was reading the wrong thing on the HPV test (I thought abnormal seemed like an odd result...). I tested negative for HPV with an HPV DNA test (or at least the 12 strains they tested for). So that's good news, yay! Disregard the last question in my list and adjust your other answers accordingly.
posted by sockypuppeteer at 1:59 PM on April 5, 2013

And, just FYI, even something as simple as your yeast infection can cause an ASC-US PAP result (paragraph under Common Changes...) and most cervical changes that lead to cancer *are* caused by high-risk HPV, which it sounds like you don't have. Please do get whatever follow-up is recommended by your doctor, though. It is totally reasonable to have a discussion about cost in advance of your appointment wherever you go. If you talk to your current gyn and feel follow-up would be too expensive, ask him/her about local sliding scale clinics and/or the risks of waiting for followup.

IANAD, although I have ridden the PAP/colposcopy/HPV result merry-go-round for a few years now.
posted by charmedimsure at 2:23 PM on April 5, 2013

My two abnormal paps were caused by bacterial vaginosis. After the first abnormal, my doc said "come back in 6-9 months to repeat" bc I was hpv negative. I had a colposcopy only because I had some abnormal bleeding. Still bv. Second pap 10 months later while pregnant - stil bv. Latest one, clear.

So, that's a long way of saying you might ask about the yeast infection or bv causing the issue, treat them, and try one more time. My doc essentially said that cervical cancer would be incredibly rare in the absence of hpv.

For what it's worth, I checked my old statements and the colposcopy was billed at $235 for the doctor plus $112 to read the biopsy. I can't find the price on the paps.
posted by dpx.mfx at 3:15 PM on April 5, 2013

Very strongly n'thing that doctors and hospitals will work with you to arrange a workable payment plan.

All of your questions about how and when to do further diagnostic tests should be directed to your doctor.
posted by yclipse at 5:17 PM on April 5, 2013

I don't know what state you're in but is it possible that yours has a program for uninsured women's reproductive health needs? For instance, I'm in Missouri and we have a program called Women's Health Services. As far as I remember, the only qualification was that I was uninsured and it covered pap smears, follow-ups, and birth control.

I have HPV and have had a colposcopy, which was covered by the program. You would apply through your Division of Family Services office so maybe check their website.

Beyond that, do indeed check with your hospital / doc. Our local and widespread hospital here, St Johns / Mercy, offers discounted care and even offers Charity Care if you qualify financially, which is essentially extremely discounted care. Applying takes a tax return and it can all be mailed in.
posted by youandiandaflame at 5:19 PM on April 5, 2013 [1 favorite]

You just need to discuss it with your doctor. Usually there are two different rates: the ones for people with insurance and the ones for people who can't afford to pay out of pocket.
posted by AppleTurnover at 7:19 PM on April 5, 2013