Costs/ Office Visits and Frequently Asked Questions: What if I live a long way from your offices but I am still very interested in learning more about breast health? So far we have had 6 women drive 5 hours from Seattle and two women drive 8 hours from Idaho. Most of the modern infrared camera technology equipment is located in imaging centers near research facilities and medical schools. Hopefully this will change in the next few years. To our knowledge we believe there are only 2 other camera systems of this caliber in Oregon. We are grant writing to have portable units that can do more traveling to other locations in the future. This is one of the reasons that Infrared Breast Health has been developing the Proactive Breast Wellness Program teaching module for women who may not have easy access to cutting edge thermography/infrared equipment but still want to pursue a healthier approach to their breast health with more of a prevention focus. SEE our link to the Proactive Breast Wellness Programs to learn more and get your copy so you can start making healthy changes and to help limit your risk factors for developing breast disease. What services does Infrared Breast Health provide? Infrared Breast Health provides two office visits as part of the evaluation: The first office visit is the day of the scan and is booked as an hour appointment. Information about your breast history, health, lifestyle and hormone use is evaluated. (See the“Patient Forms” section to print out the history sheets and patient preparation information prior to the exam.) Please bring copies of any previous ultrasounds, mammogram or biopsy reports that you may have or have access to if they are easily available if you wish to have them as part of your record. The woman undresses from the waist up and needs to cool in the climate controlled room kept at 68-72 degrees for 15 minutes. The infrared scan is done as well as a breast exam. We have female staff who are Nationally Certified Thermography Technicians, CTT. The second one hour visit goes over your scan results and customizes a program/ treatment plan based on your health challenges or needs based on the Proactive Breast Wellness Program. The clinical research project that we have been doing has been showing promising results in women being able to reverse the inflammatory changes in a 6-12 month period as shown in the Infrared scans and hormone testing in about 85% of the time if they stay on the protocol and make nutritional and lifestyle changes. We feel that this empowers women to feel that they can make a difference in their health and may provide an approach that is prevention based. Most of the women who have come to our center have been frustrated when they are told that “Something is being watched on their mammograms” but their health care providers are not telling them “What they can do about the potential problem”. They simply wait and worry until their next 6-month recall post card. Younger women with female relatives who have been diagnosed with breast cancer are also worried and they fear becoming a statistic. Allopathic medicine for the most part is treatment based not prevention based. Our center strongly feels that there needs to be more energy focused on education and prevention. This is why we encourage our clients to have the scan and the educational follow up for their first appointments at our center to customize their care. What if I live more than an hour away from your office, I am elderly or cannot afford to take another whole day off from work to come back to do the second one hour visit? We understand that many of our clients come from a distance. If you are able to come for the scan but live far away, we have been offering the one hour follow up visit as a phone consultation by appointment. Mention the issue of distance when you book the scan and then you will be given the follow up packet for the Proactive Breast Wellness Program to take with you. When the interpretation has returned to our office after being read, we can mail, fax or email the results to you and then we can go over the results and the care plan by phone in detail. What else happens on the second office visit? You will go over the scan results and the Proactive Breast Wellness Program. You will be meeting with Ingrid Edstrom, FNP, M.Ed. who will help guide you in customizing your care plan. Based on the testing she may suggest or advise and order the following: hormone saliva testing from ZRT Labs (see links), or serum hormones testing/ lipid panels/thyroid panels /morning cortisol /Vit D3 levels, if your personal care physician has not done them recently. All testing can also be made available to your physician if you request this. Ingrid Edstrom FNP, primarily acts as a consultant for your breast care and menopausal concerns and your primary care physician, Naturopath or established medical center may continue to follow you for other issues. Ingrid also works with hormone balancing using Bio-identical hormone replacement if this is necessary or desired. Our center also provides book lists and educational materials to expand your knowledge base on issues that affect women’s health surrounding peri-menopause and menopause. To learn more about Bio-identical hormone balancing or how to find a provider near you if you live far from Eugene Oregon SEE*******links to womensinternational. You will also go over your current supplement regimen and suggestions are made to lessen health risks and to customize what you are currently taking. The Proactive Breast Wellness Program protocol and supporting documents on the data disc help guide you during home study to find an excellent combination of supplements that may help with your individual health challenges. We have made an arrangement with Emerson Ecologics to provide our clients with a 20% discount on all the supplements if you choose to order through the link on the “Store” page. Emerson provides brand name products to MDs and Naturopaths and has over 125 multivitamins available from different manufactures to choose from. Depending on your scan results and physical exam she may also advise and order structural testing including mammograms, ultrasounds or MRIs. These tests may be arranged at Oregon Imaging Center across the street from Peace Health Hospital in Eugene Oregon or at a local hospital or imaging center if you live elsewhere. Surgical evaluations may also be facilitated through our offices if this is a pressing concern or is warranted. Other issues that are addressed on the second visit include Holistic approaches, nutritional counseling and other modalities that may benefit your breast health, lessen your risk of osteoporosis, lessen inflammation in the body that may be adversely affecting conditions such as hypothyroidism, fibromyalgia, irritable bowel, arthritis or heart health. Ingrid Edstrom, FNP has also worked in providing clients with information and approaches to Stress and Pain Management and issues with insomnia using Mind Body and other Holistic approaches. This relaxation CD and DVD product that Ingrid has created, is included in the Proactive Breast Wellness Program teaching module product offered on the “Store” link. Single copies are also available for your friends/ family who have stress or insomnia issues. ********** Link to WAVES of Serenity store and audio site Can partners come to the visit? If you have a partner or support person who wishes to accompany you to the appointment, they are welcome to be present. Since we need to have a climate controlled room kept between 68 and 72 degrees and temperatures vary with the seasons, your partner will probably be able to see the scan results when finished. Multiple people in the exam room change the temperature, so depending upon the conditions they may be able to watch the exam as well but that is a judgment call by the technician. What about children coming? Small children cannot be left unattended so bring a friend/partner to watch them or make arrangements to leave them with a sitter at home. If they are over 6 years old and want to be with you on the other side of a screen in the exam room and they are content looking at books quietly, we might be able to accommodate that. Discuss this if there are concerns at the time of booking your appointment. How can I make an appointment? Currently Infrared Breast Health sees clients in Eugene, Florence and Roseburg Oregon. SEE**** link in contact section for maps and how to reach us. How will I get my report for the scan? You will be given color images of your scan on photo paper at the time of your first visit to take with you. This will be helpful to compare with your interpretation which comes as a dictated report in about two weeks. The images and report together will help you monitor your progress and are also then available to show radiologists or surgeons if that becomes necessary. How long does it take to get the results? Your images are sent to a board certified thermologist for review. It usually takes about two weeks from the day of your appointment to get the report to you. You can also have a copy of your report sent to your physician. If you wish to have your results quickly, your report can be ready in 24 hours for an additional $60.00 as a stat charge. Who is qualified to take and interpret Digital Infrared Images? Interpretation of thermographic images for a clinical impression should only be made by health care providers who are licensed to diagnose and hold credentials as board certified clinical thermographers, diplomates, or fellows from a recognized organization. Any individual wishing to perform DII in their office with the images sent for outside interpretation should be certified as an infrared imaging technician by one of the same organizations. Infrared Breast Health is a certified technician imaging center. Who reads my scan? We are very pleased to have Dr William Amalu as our center’s interpreter. As the President of the International Academy of Clinical Thermology, Dr. Amalu instructs physicians worldwide on the science and interpretation of thermal imaging. Dr. Amalu brings over a decade of thermal imaging experience to patient care. In partnership with William Hobbins, MD, FACS, FABCT, of Thermal Image Analysis, our center provides over 40 years of clinical excellence in thermographic analysis and interpretation. William Amalu, DC, DABCT, DIACT, FIACT Board Certified Clinical Thermologist Diplomat, International Academy of Clinical Thermology Diplomat, American Board of Clinical Thermology Diplomat, American Board of Medical Infrared Imaging President: International Academy of Clinical Thermology Please go to Dr Amalu’s web site at www.breastthermography.com to learn much more about infrared thermography. Will my insurance cover the infrared procedure/ test and the office visits? At the present time, some insurance companies cover the procedure, while others do not. We explain it this way. It is like going to the doctor’s office and they say go down the hall for an EKG test which is considered a “procedure ”. Our office now accepts about 25 different insurances here in Oregon and the insurances will pay for the office visit and the one hour educational visit when it is coded as related to menopause, fibrocystic breasts, breast lump or family history of breast cancer etc. Only a few of the insurances have been paying for the “procedural “ part of the thermogram. We have been sending packets to the medical directors to get them to change their policy which is occurring but slowly. Our policy is to receive payment in full for the infrared thermogram at the time of service and we can provide you with the paperwork necessary for you to submit the bill to your insurance company for reimbursement in the form of a super bill for the procedure portion of the infrared scan. The appropriate procedure code for breast thermography is 93762 and 93760 for thyroid/ carotid and other parts of the body, if you would like to check with your insurance regarding coverage prior to the visit. You are given a receipt for your visit which can be used as a medical expense for your taxes How much does a Digital Infrared Imaging cost? Our center’s fee for the procedural portion of the breast scan is $150.00 which includes imaging, the interpretation fee, a dictated written report and a set of colored images on photo paper. If you have a co-pay for your insurance, the co-pay is also included in the scan fee. The office visit portion for the day of the scan and the follow up visit is separate, but usually your insurance pays for that. If you wish to have additional thyroid images on the day of your breast scan that will be an additional $40 to have them interpreted. If you need a full body scan for pain syndromes that takes more time and image sets and the cost for that which includes interpretation is $195. I am worried about finances can you do installments? Yes. Some women request to pay the interpretation portion of $60 on the day of the visit and then pay the remaining $90 due in $30 amounts over the next 3 months. If you need to pay something towards your second visit, if for example you have a large deductible, we can do that in installments too to make it easier. Do you take credit cards? Yes. We take Mastercard and Visa . HSA debit cards can also be done. We do not currently accept American Express or Discover Card. What if I do not have any insurance? The cost of the scan is still $150 and the follow up visit is discounted to $65 for the one hour appointment. In our area the Naturopaths charge $90-$125 an hour for their time but we feel that the education portion and the Proactive Breast Wellness Program is very important and uninsured women should also be able to afford a follow up appointment so they too have access to this prevention program. We have been writing grants to help provide scholarships for underserved women in the form of scholarships, but at the moment we have not obtained that funding. If you can not come back to the office easily due to long distances or scheduling issues, we provide fee for service phone consults to go over any hormone prescription changes/ supplement questions that might arise. If Ingrid can not answer your question immediately when you call because she is with another client, we can arrange the consult by appointment, so please leave a number clearly twice and a good time to call. These fees also apply to Fee For Service short office visits. A short follow up consult of 15 minutes or less is $35 and a 30 minute follow up consult is $50. We accept Visa/MC/ HSA accounts. Does my insurance company view Infrared Breast Health Center as a Preferred Provider Center? You can call your insurance company and ask if Ingrid Edstrom FNP, M.Ed. is a preferred provider for your plan. If I am not on the panel I may be considered an Out-of-network provider. Given some extra time you can also ask your insurance company to contact us so we can apply to different insurance carriers to be on their panel as a provider in their system. This sometimes takes some time however but this is the way we expand our services to more clients. Do I need a referral or Prior Authorization? Most insurances do not require a referral but if you have a plan that requires one, please contact your physician and have them fax the referral preferably 2 days prior to the scan to 541-302-6565 for a breast evaluation or menopausal evaluation. Tri-Care and some Medicare PPO Plans require a prior authorization. Pacific Source requires a prior authorization for the scan but not for the office visit. If there is a question as to whether you require one, it is better that you call your representative and find out so the insurance company will pay for your office visit portion. The scan part and what is paid or not paid is quite variable Reasons for the visit might include: dense fibrocystic breasts in women under the age of 50 where mammograms are not effective, strong family history of breast cancer, cancer survivors, pregnancy/ nursing or sensitive to radiation. Is breast thermography safe, even for pregnant or nursing women? Yes, Infrared is non-invasive, does not use radiation, does not compress the breast and poses absolutely no harm to the woman whatsoever. Is Digital Infrared Imaging an approved procedure? Yes, DII is approved by the FDA for use as an adjunctive breast cancer screening procedure since 1982. This was published in the Federal Register: Vol.147, No.20, pp.4419-4420, Jan.29,1982 Does Digital Infrared Imaging replace mammograms? No, DII and mammography are tests based on two completely different principles. They complement each other. The consensus among health care experts is that no one procedure or method of imaging is solely adequate for breast cancer screening. The false negative and positive rates for mammography are too high for the procedure to be used alone. DII can pick up many of the cancers missed by mammography. It is DII's unique ability to monitor the abnormal temperature (physiological) changes produced by diseased breast tissue that allows for extremely early detection possibly 3-10 years prior to mammograms. What Are the Advantages of Thermographic Imaging? Thermography is the earliest method of breast pathology detection known. It is the best Risk Detection Tool available to modern medicine. It can identify changes in local physiology and blood flow before other clinical examinations or screening tests are able to detect a problem. Unlike mammography, accuracy of the test is not compromised by the denser breast tissue in women under 50 years old. Compared with X-Rays, CT scans, ultrasound and MRIs, digital infrared is unique in its ability to show physiological and metabolic changes. Infrared imaging is also very cost-effective in comparison to these other screening and diagnostic tools. How Does Breast Thermography Compare to a Mammogram? Both are screening tests that do not specifically diagnose breast cancer, but screen for changes in local tissues due to various causes. Both are superior to clinical or self-examination for detecting early pathological changes. Mammography detects anatomical changes and is more precise than thermograms in identifying the exact location of a lesion, while thermography detects physiological changes that occur much earlier than anatomical changes. Thermography has been shown to detect the pre-cancerous state of breast tissue up to 10 years before breast cancer is identified by other methods, and a positive thermographic image represents the highest known risk factor for the future development of breast cancer, 10 times more significant than any family history of the disease. Compared with mammography, 7 out of 10 times infrared imaging is the first alarm that something is altering on a cellular basis in the breast. Can Breast Thermography Diagnose Breast Cancer? No. Like mammograms, it is a screening test. More specific diagnostic tests such as ultrasound, MRI or biopsy are needed to diagnose and stage breast cancer. Biopsy is the definitive way to diagnose cells as being cancerous. Does Breast Thermography Replace a Mammogram? No. Both are useful screening tools with relative strengths and weaknesses. Thermography is most useful in women who are not good candidates for mammography or who prefer to avoid unnecessary radiation exposure. Mammography can be a useful follow-up screening tool when thermography reveals a suspicious finding. When used as part of a multi-modal approach (clinical examination + thermography + mammography), 95% of early stage breast cancers can be detected. Places in Europe, Asia and Canada are using thermography as the first line of screening and if there is an abnormal scan then the woman is sent for mammograms or ultrasounds. These socialized medicine countries have more of a vested interest in “Prevention” since the state will have to pay for the treatment. How Often Should Breast Thermography Be Done? An initial thermogram with a 3-6 month follow-up establishes a baseline. Thereafter , annual thermograms are generally recommended. Other countries are suggesting a first thermogram at 20 or 25 and then every five years until 40-45. Since most cancers take 10-12 years to grow to a palpable size, watching the thermographic patterns of the breast will alert you to changes that are starting much earlier so hopefully you will have time to make changes. Can Thermography Be Used for Other Conditions? Yes, there are a number of conditions where thermography has proven to be a useful diagnostic procedure as well as a way to measure treatment progress. These conditions include local pain conditions including: · Arthritis · Tendinitis and tenosynovitis · Neurological conditions · Atherosclerotic heart disease · Carotid issues · Deep vein thrombosis · Vasculitis · Raynaud’s disease. · Thyroid issues We can also do whole-body thermography to screen for circulatory and other physiological changes. Finally, licensed acupuncturists can use thermography to detect slight temperature variations which reflect disturbances in the flow of Qi and blood, which can result in pain and dysfunction. Concrete evidence that acupuncture therapy actually restores blood flow and normalizes disrupted temperature patterns has been proven by thermographic studies. I have heard that there is a new and better type of thermography, is this true? There are always new health care technologies on the horizon, many turn out to be helpful while some are detrimental. We as clinical thermographers are always watching for ways to improve patient care through this technology. Unfortunately, there are emerging thermal imaging procedures that cause concern amongst professionals in this field. Some of these "new" types of thermography are just a renaming of what we currently do, or worse, resurrections of limited outdated technology. A few new thermal imaging technologies cause us concern due to their aggressive marketing of unproven procedures and, in some instances, omitting important diagnostic surface areas of the body from the images. Please be careful regarding these "new" thermal imaging procedures. Large scale studies will be necessary to change the proven and accepted standardized procedures that clinical thermographers currently use. What other centers perform Digital Infrared Imaging? Because of the special training, technical expertise, and unique clinical environmental needs necessary to perform DII, many centers do not have this technology as of yet. Currently, independent digital infrared imaging centers and highly specialized independent breast clinics are the most common place to find this technology. Why haven’t I heard of Digital Infrared Imaging before? Due to a poorly constructed and performed (with regards to Breast Thermography) research study back in the 1970’s, DII was placed in a "further study needed" and "no improvement over mammography" category. Along with this study, health care politics and insurance cost-containment issues caused interest in this technology to be put on hold. However, with the combination of a multitude of large-scale studies performed in the 80’s and 90’s, and recent advances in technology, DII has become one of the most important front-line procedures in early breast cancer detection. I mentioned Digital Infrared Imaging to my doctor and was told that the procedure is outdated and useless, is this true? Unfortunately, many physicians either do not know about this technology or are knowledgeable about a single poorly performed (with regards to DII) research study; the BCDDP (Breast Cancer Detection Demonstration Projects). The BCDDP was a large study done in the 1970’s that collected data from many centers around the United States. Three methods of breast cancer detection were studied: physical examination, mammography, and thermography. With regards to thermography, the BCDDP was seriously flawed in four critical areas.1. Completely untrained technicians were used to perform the scans. 2. The study used radiologists who had no experience or knowledge in reading infrared images. 3. No standardized reading protocol had yet been established for infrared imaging. 4. Proper laboratory environmental controls were completely ignored. In fact, many of the research sites were mobile trailers with extreme variations in internal temperatures. Of considerable concern was the reading of the images. It wasn’t until the early 1980’s that established and standardized reading protocols were introduced. Considering these facts, the BCDDP could not have properly evaluated infrared imaging. With the advent of known laboratory environmental controls, established reading protocols, and state-of-the-art infrared technology, a poorly performed 20-year-old study cannot be used to determine the appropriateness of DII What other centers perform Digital Infrared Imaging? Because of the special training, technical expertise, and unique clinical environmental needs necessary to perform DII, many centers do not have this technology as of yet. Currently, independent digital infrared imaging centers and highly specialized independent breast clinics are the most common place to find this technology. How can I find a Digital Infrared Imaging lab in my area? You will find an up-to-date list of international qualified breast thermography centers at this link (Qualified Centers) LINK to Dr Amalu's site.

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