Insurance Won't Pay Ordered Mammogram
When I lived in Indiana last year I received my yearly mammogram. I always got my yearly done since I have had a history of benign turmors.
When the radiologist looked at it they found a lump they just wanted to keep an eye on so they told me to come back in 6 months and be checked again to see if there is any change.
I did as I was told & luckily was told everything was alright and to come back next year for my regular exam. I was shocked to receive a bill from the hospital for over $700 for the second mammogram. In a phone conversation with the billing dept at the hospital they told me the first mammogram was paid as always but the second one was not since it was done before the 1st anniversary of the previous one. I tried to explain to them what happened and that I was TOLD to come in for that test. From there I had the same conversation with our insurance company (thru my husband's employer) and argued the same point with them to no avail.
Since then I have been turned over to collection and now am on a payment plan of $40 a month for the next 1 1/2 years!!! I HATE making that payment every month as I still feel as I did was what I was told to do by the doctor's hospital.
I now feel that I will NEVER get another mammogram ever! I will never let this happen again. Please HELP! Do I really owe this?????????????????????????????????????????????? ??????????????????????
:wallbang:
Re: Insurance Won't Pay Ordered Mammogram
A couple of things....
What diagnosis code did they use for the second mammogram? The coding would be different from an annual screening mammogram. Didn't the Radiologist recommend follow up with your regular Physician? Did you go to your PCP or Gyn for a breast exam to confirm the location of the lump and documentation on your medical record? That could be part of the problem, as well.
Are you sure diagnostic (not screening) mammograms are covered by your particular policy?
Re: Insurance Won't Pay Ordered Mammogram
I'm not sure what code they used.
I had gone to my family doctor and she is the one that found the lump. She ordered the first mammogram. After confirming something was there but they didn't seem to think serious said wait for 6 months and come back. When 6 months rolled around I called the breast center at the hospital and scheduled the mammogram. That is when the trouble started. They said everything was fine, come back in a year and then later received this bill. I told the hospital and the insurance company what happened and they argued with me that it was my responsibility. Since then my husband's insurance has changed to another company and we have moved out of state. I was turned over to collection and had to deal with them. I had to set up payments and that is where I am now...stuck with these payments for a mammogram the radioligist ordered. Now I will never get anything done thru a doctor or hospital without pre approval from the insurance company. I never want to go thru this again. And as I stated earlier it is sad that I am too scared to get another mammogram because of screw ups thru the hospitals and insurance companies. I am not sure how this mess started or if it was caused from the radiologist, the hospital or the insurance company but at 52 I will never get another mammogram. I have lost my trust in the health care system.
Re: Insurance Won't Pay Ordered Mammogram
No doctor is going to be aware of the limits of your medical coverage, nor care. The doctor has a duty to do what is best medically for the patient.
The insurance company, based on the details of your policy, only has to do what is stated in the policy. It makes no difference what any doctor says.
Now if the policy does indeed cover what you had done and it was given the wrong code by the medical facility, you would have to explain it to the facility and have them resubmit the bill
Otherwise, you are responsible for the bill.
Re: Insurance Won't Pay Ordered Mammogram
I think I see why this happened. You said that when 6 months rolled around YOU calle the breast center. Shoulda been done by the doctor, not you.
Re: Insurance Won't Pay Ordered Mammogram
Quote:
Quoting
truckinkat
I think I see why this happened. You said that when 6 months rolled around YOU calle the breast center. Shoulda been done by the doctor, not you.
Exactly! You should have obtained a prescription for a follow up diagnostic mammogram from your FP. Was the breast center at the hospital the same place you got the first mammo? If not, they had no way of knowing you were there for a follow up for a specific problem. The prescription/referral from your FP would have indicated the area of concern/focus to the Radiologist. By presenting yourself, without a Rx/referral, the breast center probably submitted the claim as a screening mammogram.
IMHO it would be a real shame for you to refuse future mammograms, especially given the fact that you do have a previously documented breast lump. Honestly, this was YOUR mistake. No one else "messed up".
Re: Insurance Won't Pay Ordered Mammogram
If you call your doctor and explain the situation this might be correctable. The insurance billing could be recoded if the radiologist received a proper referal. Have you called your doctor's office to discuss the problem? This sounds like an insurance billing problem rather than a health care system problem. You received the health care, and the peace of mind in knowing there's not a problem. Now it's just a matter of getting it paid for correctly.
I know years ago we didn't need to concern ourselves with such things. We just went to our doctor, did as we were told, and everything got paid for. Those days are over and we all have to take an active role in making sure things are gotten right.