Dx mamogram not covered....

Mary1223

it's been 10 years since I've been here. In June of 2012 calcifications were found on my right breast. I was told to get another mamogram in 6 months . I didn't go because my insurance only covers routine mammograms once a year. So in June 2013 I went back for my "routine" mammogram and there were no changes. However I was sent a bill for $500 because the scrip was for a diagnostic mamo, which I didn't know. I explained I specifically didn't have  the 6 mo mamo, because it wasn't covered, but because my dr wrote for a dx mamo I am getting bills which because I'm on a fixed income I can't afford to pay. Does this mean I can't have another mamo because it will be considered a diagnostic? Is there any way i can find relief from these constant phone calls?

I'm ten years cancer free.

Chickadee

I'd be on the Drs coding people to fix this for you.  You shouldn't have to. It doesn't sound diagnostic to me.  

MelissaDallas

Yes, ask your doctor that your script be for a screening only. Then they will only call you back for a diagnostic if necessary, although if it IS necessary you'll still be in the same spot. 

He is doing the correct thing though by giving you a diagnostic when they wanted to follow up on prior findings.

ziggypop

Hi Mary, first off - congrats on being 10 years cancer free - Yay, Yay. That is perhaps the most important thing. As far as the mammograms go - call the hospital about the one that they are trying to make you pay for now - see if you can negotiate them down. In the future, call your insurance company - since they can't 'drop' you now, you have some leverage (i.e. they would rather pay more for a diagnostic mammo, than pay for chemo, rads, etc. 

bevin

Call you insurance company and place a written request for review to pay. You can and should officially ask them to re- consider and state you want to appeal the decision.  Often, upon written request for review and request for an appeal they pay. As for the bill, set up a payment plan, 10$ a month will keep you from collectors while you appeal the decision.  The hospital or service provdier is required to set up a payment plan for you.