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.
We had an international PhD student visiting our lab to do research this past semester. She had to go to urgent care when she was sick in February.
Skip to May… one day I’d asked her how her weekend went and she said it was terrible because she found a piece of mail that had gotten mixed up with her roommate’s mail, and she was nearly “a month late” on paying the medical bill. She was panicking a bit about how she was going to come up with a few hundred dollars quickly, and was very worried about it being “late” (it was sent in April).
I asked her a few questions and realized that she was, of course, just clueless about how medical billing in the US works. I told her “All these numbers are not real: the due dates, the money, they’re just made up. Do NOT pay that bill right now”. I explained the whole dealio to her and she was relieved but baffled. So the next day an American lab member took her to the clinic and helped her negotiate a huge price reduction, and coordinated getting her records to the insurance company to see if they’d pay more of it. She was SO relieved and happy, and also amazed at how messed up things are here.
I learned that even if the hospital billing company sends you ELEVEN notices on ONE day (yes, 11 notices arrived over 2-3 days but all dated the same date on the notice) that your account will be sent to collections if you don’t pay within 10 days, the law says they can’t send you to collections until 120 days after the bill is sent. They can’t charge you interest or assess late charges. You can set up a payment plan without fees.
They don’t have to tell you that.
I always told our grad students to negotiate hospital bills. Student insurance is not the best, and the charges can really add up. Every student who had a huge bill was able to negotiate it down before it was sent to collections. They couldn’t pay it, so the hospital helped “find” assistance to reduce the bill.
Just remembered one more medical bill challenge:
After my dad died, his medical insurance declined an expense because my dad had died before they received the bill.
It took some work to convince them that he was alive when the services were provided.
Our insurance only pays for the initial mammogram; any additional diagnostics, regardless of the reason, are not covered UNLESS you are diagnosed with cancer as a result of the test. I had an MRI that cost $880 bc it was negative. This is why less affluent women die.
“In New York, state law mandates that insurance companies cover breast ultrasounds as a supplemental screening test for women with dense breasts.”
Each state is different. It is where the insured lives, not where the policy is issued.
My ultrasound did find a new mass. I am going to have to a follow up ultrasound in 6 months. i would need to pay my deductible for those follow ups.
I discovered this state discrepancy also. In NJ I was scheduled routinely for an ultrasound with my mammograms due to dense breasts. Moved to MA, they won’t schedule an ultrasound until after they see something they don’t like on a mammogram. Took me a few months to find this out, the imaging place just wouldn’t schedule an ultrasound but never told me why. Of course, once I got the mammogram, the radiologist determined I did need an ultrasound on my left breast. Now, in MA I am on a regular schedule for ultrasounds on that breast only.
Just make sure they include the diagnostic code for dense breast (R92.3) alone with medical code for ultrasound screening (76641 or 76642). Without the diagnostic code my insurance wouldn’t pay for the annual ultrasound.
I just don’t know why a patient should need to know any of these. The funny thing was no one would tell me what the codes should be or what was missing, but all I had to do was to just google it. I was the one who told the billing how they had to do it.
I actually think I am OK, because the radiologists in MA are now considering my left breast to have an abnormality vs just being dense!
Coming back to the original question,
a) ask for a printed copy of the entire itemized bill
b) review it for other erroneous charges
c) contact the hospital administrator and patient relations in writing to explain the situation and that this is an erroneous charge you want removed and copy your insurance company
If the insurance is Medicare, they have a procedure too.
This mammo discussion is reminding me of some peculiar quirk in colonoscopy coverage which my gastro has tried to explain to me. Screening colonoscopy covered if you meet the clinical guidelines; other types of colonoscopy not necessarily covered. I’ve asked “it’s a screening procedure- why else do you do one?” and was told that if you pick up the phone to say “I have XYZ symptom” and the recommendation is a colonoscopy it might not be covered.
This makes zero sense to me. But I guess the question “when is a screening procedure not a screening procedure” is for greater minds than my own.
UPDATE:
My dispute with the hospital was “concluded” with the hospital saying that my objection was considered irrelevant. Because I stayed overnight on a hard stretcher in the ER with no private room, no hospital bed, and no bathroom, leaving me to wander the halls when I needed to use the restroom, I have officially received “the same care” as I would have if I’d actually been given the room to which I had been admitted.
The woman said the decision was “final.”
My insurance company didn’t seem interested in helping me, since they had already covered everything they were going to cover.
Any further ideas?
This really irritates me. They are charging me the same as a person who got their nice private room, state of the art bed, and private bathroom. While the medical care might have been the same, that in my mind does not make the experience equitable.
That’s so bad. Is there any kind of regulatory agency that oversees hospitals? I’m so fricking fed up with hospitals. 
I hate it when my son is stuck on a stretcher in an ER hall, right in the middle of all the commotion. Sometimes it’s for more than a day.
Try contacting the hospital administrator
There might be a hospital ombudsman, also.
When Dad fell in the hospital while on “fall watch” and broke some teeth and his nose, we told them we expected them to cover his expenses. They said no. So his RN advocate went in and had a little talk with them and they changed their mind.
This is irritating 
! It would make a good investigative segment on local news. That would be my stop after exhausting all other options
I agree with trying to find hospital ombudsman and/or local news station investigative reporter.
I was escalated to billing supervisor of hospital and got her email and I told her they needed to recode and resubmit the bill. I further told her we would only pay copay after they recoded and resubmitted. I followed up with an email reminding them to recode and resubmit so we could pay our copay AFTER they get insurer to pay on properly coded & submitted bill.
I would ask what is the rack rate for the ‘room’ charge for hanging in the ER for 24 hours? (as opposed to the Med-Surg inpatient private room rate)
@bluebayou — that makes good sense to only pay the negotiated reduced rack rate your insurer would pay for being in ER for 24 hours and NOT a hospital room.