Breast lump, no insurance, no money, looking for options.

September 12, 2013 8:09 PM

Having found the lump a year ago this June, it took me until today to find the courage to try doing something. Many of the sites I found said to go through my local health department, so I finally worked up the courage to walk in today. They had no idea what to say, and no longer offer any program that would help. I walked out with a pamphlet for a clinic in another town that they think "might" have a program to help with a sliding payment scale but they weren't even sure about that.

About a year and a half ago I found a lump in the outer side of my right breast. Dr Google said that sometimes it happens around period time and goes away afterward, so for a while I ignored it but over the next year it doubled in size. Also, in the beginning I had to search for it, now I can find it easily. It hurts sometimes, my bra's fit differently, and yes I'm scared.

I've tried searching for programs that will help with the process of getting it checked and whatever treatment might have to follow. Unfortunately the more I find, the more confused and scared I get. Yes, there are programs. Many of them require a confirmed diagnosis before you can qualify for assistance. Most of the "free" ones I can find are specific to single moms (no kids here). Many of the others have rules and steps involved that I can't even begin to understand, and it looks like with most of them I can screw myself out of qualifying for assistance by starting with the wrong doctor or not knowing about a certain form.

I'm single, I have no family to speak of (those I'm on speaking terms with have no ability to help in any way), no close friends to come along and hold my hand through the process. I'm lost and alone and looking to talk not to Dr Google but to people who have actual experience and can tell me what they did or how they went about finding help.

Yes, I do plan to see a real doctor... I just have no idea what I'm doing, and after the health department being as clueless about it as I was my confidence in "just call and talk to someone" is kinda shot. More than ever I feel like I need to at least have an idea of what I'm supposed to do before I go back.

Maybe it will turn out to be some benign nothing to worry about, but I can't stop worrying about all the "what if" of possible treatment, managing to work enough hours to cover basic living expenses like food and rent (which are already a paycheck-to-paycheck struggle).. somehow it has been less terrifying to just be irresponsible and hope its magically nothing.

posted by myShanon to Health & Fitness (23 answers total)

Good on you for taking action.

Is there a Planned Parenthood in your area? They offer all around Ob/Gyn care, not just contraceptives. Google "free clinic", "women's clinic", "breast clinic" for your general geographic region. Then call before you go in. Hopefully someone can at least refer you to a low-cost clinic where you can get a mammogram.

If you can't find anything at all local, try calling these folks who can offer emotional support and probably can point to more local resources.

I would also suggest telling someone, even if it's just a trustworthy coworker, about this. Partially so you can have support dealing with a scary situation, but also so they can help you stay accountable for following up. It would be easy, given the challenge of finding care, to stop dealing with this again.

Rooting for you...
posted by latkes at 8:14 PM on September 12, 2013 [3 favorites]

Response by poster: There's a Planned Parenthood not in my area but one I can get to within a 45 min drive, but I haven't been able to find information on how far they go... or whether going through them for the initial screening/etc part would disqualify me from programs that I might need to take advantage of further down the road if treatment is necessary.

Apparently PP goes through a foreign call center now, so I can't even just call the office I went through in my search for birth control... and all the people at the call center really do is schedule appointments. They didn't even warn me before I got my IUD that I was supposed to be on my period and take painkillers first (made for a very unpleasant experience that could have been easier).

I live in a small town in Oklahoma, about 45 min from Tulsa. The state has a million dollar grant with PP for "family planning" insurance that covered birth control and a yearly exam, but I haven't been able to find answers on exactly how much that would cover in this situation.
posted by myShanon at 8:21 PM on September 12, 2013

Hey there — I know what it feels like to find a lump. I found one last year, and I went to my primary doctor and she was very alarmed and sent me in for a mammogram right away. Thankfully, the painful lump my primary doctor was worried about turned out to be a cyst and it has since gone away. That was six months ago. While other outcomes are possible, keep in mind a good outcome is possible too.

So take a deep breath and reach out. There are lots of resources for people in your health insurance situation to get an exam.

Planned Parenthood is a wonderful, caring resource and a good place to start. Right now you need some advice from experts, so call them during business hours and talk to a health professional there. If you're worried about being "disqualified" for other care, you need to talk to a health expert who can walk you through your situation and options.

Some other options for you:

Your profile lists your state as Oklahoma. OK has a free screening program that is mostly designed for older women, but takes younger cases by exception. Call them and ask: 1-888-669-5934.

Or try the Oklahoma Project Women which seems designed for you and offers many free resources: "Oklahoma Project Woman is a statewide comprehensive program providing free mammograms, diagnostic procedures and surgical services for Oklahomans with no health insurance and limited financial resources." Call them: [phone].

You are not alone. Hang in there, and keep reaching out for help.
posted by amoeba at 8:25 PM on September 12, 2013 [6 favorites]

This is purely gut instinct, but if you really have no money and it's a fairly obvious thing now that hasn't gone away, I might try calling hospitals in the area ahead of time to make sure that they have a charity care policy, and then show up in the emergency room. EMTALA requires screening at least, doesn't it? No, I'm not positive this would work, but my inclination is to say that it would be better to try it and see, if the resources posted above don't pan out.

I realize people say not to go to to the emergency room except for real emergencies, but I at least think you'd be personally justified treating this like it is one until you have information that suggests otherwise.
posted by Sequence at 8:32 PM on September 12, 2013 [1 favorite]

Response by poster: The "OSCH" free screening program I think is the one I was told to go to my local health department for, that they don't offer anymore. The pamphlet they gave me is out in the car so I don't remember offhand. The lady I talked to said she wasn't sure how much they cover beyond screening, but she was pretty certain that it was mostly just a sliding payment scale.

I can look into whether Oklahoma Project Women is available somewhere I can get to.
posted by myShanon at 8:33 PM on September 12, 2013

Response by poster: @Sequence I'm not sure that "there's this lump" would qualify as an emergency room issue? I've never been to the ER so all I have to go on is tv shows where they refer people back to clinic or similar if its not a life threatening issue?

If I were to start feeling sick or have other symptoms I'd try it, but right now all I have is a hard spot that makes me uncomfortable (and itchy) most of the time.

Oh, and little dogs who LOVE standing on exactly that spot, just in case I forget where it is :)
posted by myShanon at 8:36 PM on September 12, 2013

Here is a link to information about Federally Qualified Health Centers (FQHC) in Oklahoma. They should be able to help you connect with a sliding-fee clinic and/or Medicaid assistance. Many clinics of this type have programs devoted to dealing with this type of medical issue. Good luck!
posted by uncaken at 8:45 PM on September 12, 2013 [2 favorites]

If one of the little dogs jumps too hard on your lump and it continues to hurt afterward, that absolutely is a valid reason to go to the ER.

I had a sebaceous cyst on my face in my twenties (think "ingrown pimple") and I spent two months during the holidays trying to get a regular doctor's appointment. No dice. Not a priority and they were backed up, even though it was gradually getting bigger. Then my infant son stomped my face and I ended up in the ER and got a referal to see a surgeon a week or whatever later and ended up having outpatient surgery to remove it.

So, yes, there are circumstances under which this could be something you go to the ER for and get taken seriously.
posted by Michele in California at 8:47 PM on September 12, 2013

check your memail.
posted by deliciae at 8:49 PM on September 12, 2013

All those stories about how people take up emergency room resources with non-emergencies? They're people who go there for stuff that doesn't require a doctor at all (like just wanting pain pills) or people who go there when they should be going to a Minute Clinic or something because it's just a sinus infection. This is not something the Minute Clinic can do. At the very least, you're not any *worse* than people like that. Given the potential severity of the situation, I would say you're a number of orders of magnitude better. Yes, it's possible this might get treated dismissively, but I think there's a pretty good chance it won't.
posted by Sequence at 9:04 PM on September 12, 2013

The ER is pretty pricy. Can you see your doctor right away? They can get get you in for an urgent mammogram. You might also have a breast ultrasound. Tell your doctor and any care providers that you're a. incredibly anxious and b. broke. Ask them to give you the insurance company price, and to work out a payment plan.

here are some leads on affordable care:
http://www.newchoicehealth.com/Directory/CityProcedureType/Oklahoma/Tulsa/13/Mammogram
http://www.newson6.com/story/7157158/breast-screening
http://www.oklahomaprojectwoman.org/
http://breastcancer.about.com/od/Free-Stuff-Cancer/tp/Find-Free-Mammograms.htm
http://www.cdc.gov/cancer/nbccedp/

Please come back and let us know how you're doing.
posted by theora55 at 9:06 PM on September 12, 2013 [1 favorite]

The 'pricy bit', btw, is why I pointed out calling about charity care policies beforehand. If you're really broke, there's a fair chance that they will at least decrease the cost, if not waive it entirely. Not-for-profit hospitals have to provide charity care to qualify as such.
posted by Sequence at 9:10 PM on September 12, 2013

If I were in your position, I'd contact Planned Parenthood, the LiveStrong Foundation, and the Susan G Komen Foundation.

(I will be thinking about you. Please keep us updated about this!)
posted by MexicanYenta at 9:39 PM on September 12, 2013

Go to Planned Parenthood! They will definitely help you out, just make an appt and show up. If you need treatment and have no insurance thy might be able to help you with that, if they don't call LiveStrong, the Susan G Komen Foundation and Catholic Charities. My parents volunteer with CC and a ton of that volunteer work is driving people hither and yon to free or cheap clinics and Catholic hospitals. I don't know what the network is like in Oklahoma but it's definitely worth a try. Also, you don't have to be Catholic, no-one cares.
posted by fshgrl at 1:04 AM on September 13, 2013 [2 favorites]

I was exactly in your position about two years ago. Breast lump, no insurance, panic.

I went to my local Planned Parenthood, and they saw me for...not free, but a sliding scale. I think that it was about $50, all said. They verified that there was, in fact, a lump, and they had a partnership with a local cancer center. They referred me there, and a week later, I went there, paperwork from PP in hand, and the cancer center saw me for free.

Obviously it's not like this everywhere, but Planned Parenthood and similar organizations are used to working with women who have few resources on this front. They have ties to other organizations, and are aware of the options that are out there for people in your shoes. To the best of my knowledge, there aren't any programs or organizations that will bar you from receiving help because you've also received help from PP. (Possibly if you magically end up with insurance in two months they would refuse to cover this, because seeing someone about it makes it pre-existing, but outside of that...)

Try not to panic too much just yet. In my case, it was a very dramatic and painful cyst, but no cancer. We're trained to think of "lump in breast" as a huge and terrifying problem, which I think can end up being paralyzing for a lot of people. There are outcomes here that are not cancer and crisis. Call and make an appointment--regardless of what this is, knowing will almost certainly make you feel better, because then you can do something about it. Be safe. <3
posted by MeghanC at 9:00 AM on September 13, 2013 [5 favorites]

Planned Parenthood.

I doubt very seriously you'd be disqualified for other programs depending on where you start your diagnosis.

I find that Planned Parenthood has excellent resources and very caring folks working there.

Start there.
posted by Ruthless Bunny at 9:43 AM on September 13, 2013 [1 favorite]

This is a long shot, but if you happen to be in Minnesota/Twin Cities area, you should check out the SAGE program http://www.health.state.mn.us/divs/hpcd/ccs/screening/sage/... It does sound like your dept of health would have pointed you to this resource though...

Otherwise, I would say what everyone else is saying too -- go to Planned Parenthood. If they can't help you, they are very likely to know someone who can. Good luck. That is very scary, but get ye to someone, anyone who can diagnose this !!
posted by dubhemerak3000 at 10:23 AM on September 13, 2013

There are many causes for a subcutaneous lump, and it won't do you any good to panic before you get tested when it could turn out to be very minor. That said, you definitely do not want to delay getting tested.

Twenty-five years ago my mom was in the same situation. At the age of 38 she was working retail so we had no health insurance. She found a lump, and waited over a year before going for a biopsy. Unfortunately it did turn out to be cancer in her case. She was able to pay for the subsequent surgery and chemo thanks to our state's low income assistance programs (Medi-Cal) but we still went bankrupt and were on food stamps/welfare for a while as the medical bills piled up and she was unable to work. Her doctors told her that if she had been diagnosed sooner she may have just needed a "lumpectomy" and less aggressive chemotherapy. Catching it earlier may have helped her avoid the recent, aggressive recurrence of the cancer we're currently dealing with decades later. Please, please get tested as soon as you can.
posted by Thoughtcrime at 4:42 PM on September 13, 2013

I'm an ER doctor. EMTALA requires screening only for emergent conditions. It does not require screening for any possible medical condition. They cannot get you an emergent mammogram.

You are far better off going the Planned Parenthood route.

I know nothing of Oklahoma's vagaries but I feel like the "don't do anything because if you do the wrong thing you'll disqualify yourself from other help" is probably untrue, is scaring the hell out of you needlessly, paralyzing you and keeping you from getting the help you need for your health and to prevent this from potentially becoming something more serious and expensive. I suggest you completely put those thoughts aside for now and focus on forward movement.

If you really cannot get to Planned Parenthood, you can go to the ER (go to a larger medical center/hospital, not a tiny urgent care or freestanding ER) without checking in as a patient and talk to a social worker and/or a financial counselor there. Their jobs are to help people who don't know how to navigate the system to get assistance. If you don't have money for insurance and don't have insurance you likely qualify for the state coverage. They will make sure you fill out the right forms.
posted by treehorn+bunny at 7:23 PM on September 14, 2013 [2 favorites]

If you were my daughter I'd tell you this: It's time to stop dancing around this with one excuse or another because you're scared to death and get this checked out right now.

I'm not at all sure that a standard mammogram is what you're looking for, mainly because my daughter had a regular mammogram because she was having breast pain (she was 46) and then they referred her for a "diagnostic mammogram" - if you can believe that. Then she had a breast ultrasound, which finally determined that there really wasn't anything to worry about. So she paid for two mammograms and the ultrasound; she had insurance, but the deductible was so high the whole thing still cost her a small fortune.

You, however, have a significant lump that is palpable and growing. My guess is that any doctor worth his salt will send you directly for the ultrasound and skip the basic mammogram entirely. Get thee to a women's clinic at once - Planned Parenthood is superb - and be seen by a physician and if he sends you for a mammogram, ask him about the ultrasound instead. The ultrasound doesn't cost any more than the mammogram but because a tech is actually visualizing the lump and surrounding tissue while doing the exam, he can get more specific info. I'm not a doctor, though, so get whatever the doctor says. Do see a doctor, though.

Whatever - forget all the reasons you have for putting this off and get it checked out now. Please.
posted by aryma at 10:31 PM on September 14, 2013

Response by poster: Thank you everyone for the advice, most of the links you've shared for the Oklahoma area, or the Komen foundation are ones I've already looked at and been completely unable to understand what I need to do to qualify. I have found many different programs, but as in my original post many of them require specific steps to be followed in order to qualify for their program. As best as I can understand everything I've been reading, I really could screw myself over by going to a doctor who isn't associated with any of the programs, or doesn't fill out the right forms.

I do not have a doctor currently, as not having insurance or money to spare I have no way of having access to a regular physician (in response to the "go see your doctor today" comments).

I'm not assuming its cancer, however I like to prepare myself for worst case scenario.. That being, if it did turn out to be cancer, what basic treatment options are, if chemo or something made me unable to work how would I get my bills paid. Not because I'm in a panic, but because I know if it does go that direction, I *will* panic if I don't already know what some of my options are.

I'm not affiliated with any religion, and would prefer not to participate in any church program... They're great people, I know... but having someone tell me that this or that is god's plan makes me so angry I have trouble remaining civil. If I can avoid being in a situation where I'd end up antagonizing the people trying to help me, that would be best for everyone involved.

Based on a lot of the suggestions here and some personal stories shared in memail I'm thinking the best course of action is to either try the clinic suggested by the people at the health department, or go to planned parenthood and request to sit down and Talk to someone... Not be looked at yet, because conversation does not create that pre-existing medical condition record...

I would have loved to just call and talk to someone over the phone at planned parenthood, but since they're outsourced to another country now their "customer service" isn't really connected to the information I need. Or at least, that was the case when I went through them to get my IUD a couple of years ago. The person I scheduled the appointment with didn't even bother to tell me the things I should have done to prepare, which would have made the procedure much less painful than it turned out to be.. (no, I'm not bitter about that... yes I am.)

I've tried email contact from a couple of websites but the response is usually to give me more web links to sites that I don't understand (ever try to read something in another language? That's how much sense most of these sites make to me). Hopefully a verbal or face-to-face conversation will make it less confusing.
posted by myShanon at 9:15 PM on September 16, 2013

Breast cancer runs in my family. My sister has had several occurences. She kept working. She had to. She needed to for the insurance. She typically scheduled chemo for Friday so she had the weekend to recover. So some people do manage to work during treatment.

And some church programs are not pushy about religion. I am homeless. Some church run programs for the homeless are revolting attempts to blackmail needy people into listening to sermons. Others are sincerely done from a desire to serve, to act on their own beliefs. So while I understand your attitude, please don't throw the baby out with the bathwater. Make a few calls at least. You can walk out if they get all preachy on you.
posted by Michele in California at 9:54 PM on September 16, 2013

Response by poster: Just a quick update because I promised earlier. I'm still working toward finding an answer. I eventually found a friend who had gone through Oklahoma's Project Women when she had breast cancer. The program covers costs of getting the mammogram and other tests to find out whether or not its cancer, and will work with another program in the area if a positive diagnosis of cancer requires treatment. They even helped me find a clinic in the area that has the sliding scale that means since I only work part time and have no insurance I can still get care at a portion of the cost.

I've been through the initial exam and mammogram, although the clinic has been dragging their feet since then. I called them several times last week only to have them claim that the mammogram results hadn't been transferred to them yet. I believe this is a lie, however, since the hospital sent me a letter saying that based on the mammogram they want me to go back in for an ultrasound. Unfortunately because I received this news in the form of a letter rather than in a professional setting where I could have asked questions of the clinic's nurse or doctor I have no idea what this really means. I've had to look for answers online, which involved a lot of panic and freaking out although friends have assured me that the ultrasound is just another diagnostic step for them to figure out whether the lump is solid (cancerous?) or filled with liquid (which apparently would make it a cyst)... and depending on how that goes they'll do a biopsy next.

Honestly I'd be happy to skip straight to biopsy, and I'm displeased with the clinic and their "don't call us we'll call you" attitude.
posted by myShanon at 7:42 PM on November 10, 2013