Regular mammogram vs. diagnostic mammo

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ej01
ej01 Member Posts: 155
edited June 2014 in Employment, Insurance, and Other Financial Issues

Because I had breast cancer, I get diagnostic mamograms now.  On my cancer side i get them twice per year and the other side once per year, along with ultrasound.   I am frustrated because only annual 'regular' mamograms are covered 100% as a preventative service.  Diagnostic are covered 80% once deductable is met.  The problem is that I have a very high deductable and (hopefully) will not meet it this year, so I basically have to pay out of pocket for my mammograms.  I would think that the insurance company should have to pay at least the portion of benefit that they pay for the annual regular mamo as a preventative service, but they say no...it is a totally different procedure.  Has any one else run into this?  Have you gotten your mamo provider to code it in such a way that the insurance company will cover part of it as a preventative service at 100%.

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  • crabbiepattie
    crabbiepattie Member Posts: 108
    edited September 2013

    My insurance situation is the same as yours, but I think my mammo provider is able to code the diagnostic mammo so that I don't have to pay the whole amoun. Let me see if I can dig up some specifics to PM you. As an aside, they haven't done an ultrasound the past few times so maybe that helps their coding; the mammo center assured me a diagnostic mammo doesn't always require an ultrasound.

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  • ej01
    ej01 Member Posts: 155
    edited September 2013

    Thanks crabbiepattie.  they do an ultrasound because of dense breasts, and I knew that would be extra.  I will probably need them for the rest of my life.  It just bothers me that they are not covering any portion of this as 'base'. 

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  • bevin
    bevin Member Posts: 1,902
    edited September 2013

    Both my diagnostic and normal are fully covered.  Is it possible to speak to the clinic and ask them to accept the payment from Insurance due to financial strain. Sometimes they will work our finanaical assistance programs.  Good luck to you.

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  • Hislady07
    Hislady07 Member Posts: 1
    edited September 2013

    I'm having the same problem - $$ out of pocket twice per year., and around here at least, it is not an insignificant amount. I don't understand why I can't just have at least one of them be a regular ol' breast squashing mammogram, paid for 100% like the rest of the world.



    Will let you know if I ever discover a solution!

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  • dogsandjogs
    dogsandjogs Member Posts: 1,907
    edited September 2013

    I am tired of fighting the insurance company so just get a regular mammogram.  I can also schedule those myself which is much easier and avoids a doctor visit.

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