Dx mamogram not covered....

Mary1223
Mary1223 Member Posts: 31
edited June 2014 in Employment, Insurance, and Other Financial Issues

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.

· Share on FacebookShare on Twitter

Comments

  • Chickadee
    Chickadee Member Posts: 4,467
    edited January 2014

    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.  

    · Share on FacebookShare on Twitter
  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited January 2014

    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.

    · Share on FacebookShare on Twitter
  • ziggypop
    ziggypop Member Posts: 1,071
    edited January 2014

    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. 

    · Share on FacebookShare on Twitter
  • bevin
    bevin Member Posts: 1,902
    edited January 2014

    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.

    · Share on FacebookShare on Twitter

Categories