I am still working on few bills with my medical provider.
My doctor ordered a mammogram and ultrasound for my annual exam because I have dense breasts. I was surprised when I saw I had a copay for the ultrasound because in my state ultrasound is supposed to be paid 100% if a woman has dense breasts.
I called my insurer about it. They said the way it was coded the claim was paid correctly. I asked how it was supposed to be coded and was told they couldn’t tell me.
I then called the hospital’s billing department about it. They said they filed it properly based on my doctor’s prescription. I asked what was the order. They said they couldn’t discuss patient’s diagnosis. I literally said, “I AM the PATIENT.”
After this going back and forth it was finally determined that the doctor should had indicated I had dense breasts so they could include an another code in the claim.
This took over 2 weeks of back and forth.
They also said I had to come back to get another mammogram done because it wasn’t clear and it would be no cost to me. You guessed it…they submitted another claim to my insurance for the second image and my insurance paid for it, with no out of pocket for me. When I raised it with the billing they asked me why I should care if it’s no cost to me. I am not sure if I am going to deal with this one even though I don’t think it’s right.
I never pay my medical bills until everything is straightened out. OP - hold off on paying your bill.
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