How to get insurance to pay for screening ultrasound

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Petitegal127
Petitegal127 Member Posts: 123
edited February 2016 in Employment, Insurance, and Other Financial Issues

Another post about fighting the insurance company. I had a 6 month follow up in January. For abnormal mammogram back in July. All is stable for now. Here's the issue, I get a bill from the radiologist, insurance won't pay for the ultrasound. My doctor wanted an ultrasound because of high density issue. The radiologist was refusing to do it and after my urging and me signing a consent form to do the test they did it. What if something was missed on mammogram and the ultrasound picked it up, I did not want to take a chance. They said since the mammogram looked stable no need for ultrasound. Now I am hit with the bill, insurance said they do not pay for ultrasounds only if the mammogram showed something like a tumor or suspcious mass they would pay. Can I refuse to pay this bill? Can I fight it further??? The doctor wrote a detailed letter to my insurance company before with my breast history and that didn't do a damn thing. If I have to pay this, can I bargain with the insurance company and say look you are charging me this amount but I can only afford this amount???? I hate to ignore it and it affect my credit report down the line.

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  • LisaAlissa
    LisaAlissa Member Posts: 1,092
    edited February 2016

    Next time, talk with the insurance filing people in the radiologists office and in your doc's office about getting pre-approval. You may have to do it as a two-step procedure. First have the mammogram. Get a report back that says "too dense...can't see to discern clearly something that concerns them and suggesting an ultrasound." (Talk with the insurance filing personnel in both offices to see what language they suggest.) Then get an order for an ultrasound, and get your insurance company on board before the ultrasound.

    For this one? The insurance filing people may be able to help you refile, with reference to your docs letter and the density of your breasts & the need for an US as perceived by your docs.

    However you do have to pay it. (That's what the consent was likely about...consenting to pay, if your insurance company wouldn't.) At any rate talk with the radiologist's office about a negotiated price or about a payment plan.

    Sorry to hear your news.

    LisaAlissa

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  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited February 2016

    Too, part of the problem is that a six month follow up isn't considered screening. Insurance companies consider that diagnostic. I have the same problem with MRIs. They consider them a diagnostic test

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  • Hopeful82014
    Hopeful82014 Member Posts: 3,480
    edited February 2016
    If worse comes to worst and you do have to pay the bill, ask if there is a discount for payment in full or for charges not covered by insurance. Every little bit helps... And good luck.
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  • Petitegal127
    Petitegal127 Member Posts: 123
    edited February 2016

    Thanks for all the tips ladies! This time around I will try and negotiate the price of the bill.

    Melissa does your insurance cover your MRI's? Just wondering?? Since my doctor said if I continue to have issues she would suggest a MRI. If the insurance doesn't pay I won't get it. My insurance refused to pay for a 3D Mammogram, so I declined getting one. We pay a good bit into this plan and employer pays rest. Just ridiculous for us to put out any more money.

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  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited February 2016

    No. They say that MRIs are not screening tools. They are diagnostic tools. Even if it was covered it wouldn't do me any good because my deductible/coinsurance are so high. I'm taking heart in the fact that MSK is no longer recommending MRI annually for LCIS. Just six month alternating mammogram and clinical breast exam.

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  • Petitegal127
    Petitegal127 Member Posts: 123
    edited February 2016

    Thanks for the info Melissa.

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