I’m hoping for advice on how to successfully file an appeal for charges on a preventative mammogram. The issue is that unbeknownst to me, the hospital used 3D tomosynthesis. My insurance company, along with several others, considers that this new technology is experimental and unproven despite many positive studies which they list on their website. I have no idea how to approach this, but I’m frustrated that my free screening mammogram is going to cost close to $100 in hospital and doctor charges. It doesn’t seem right, and I want to file appeals as a matter of principal. How do you approach this with the best odds for success? Also, I hope this is a heads up for other women getting screening mammograms. You may want to read up on the pros/cons of this new technology and if your insurance company will cover the costs. I wish I had known so that the bills wouldn’t have been an unpleasant surprise.
Probably in the pages and pages you filled out you agreed to accept responsibility for uncovered charges. But I would be upset also. Since you say “unbeknownst to me”, I would complain to the hospital!
They are required to provide written notification before the procedure or post a sign letting patients know that insurance may not cover. Did they do this?
Agree, direct this at the hospital. I’m having this same problem with dentists…who no longer seem to clean teeth…they do periodontal cleaning - something my dental insurance doesn’t cover. The mammo center should not have done 3D as a prevention screening, in my humble opinion. Regular 'ole Digital or nondigital old school mammo and then if something needed close inspection, 3D.
I chose to get the 3D mammogram. The hospital charges me $50, paid before the procedure. Insurance covers the rest.
I chose to get 3D, also (for the past two years). But I knew upfront that there would be a $25 fee to the hospital, plus an additional $35 fee to the radiologist to read the 3D. The first year I only paid the $25 hospital fee (radiologist never sent a bill), but this year I paid the $25 + $35. Money well-spent, IMO.
My radiology office has signs posted in the waiting area, dressing rooms, test rooms and I had to sign a paper upon check in that I acknowledge my insurance may not cover the test, even if ordered by my MD. That also included a routine test OR a test because of a suspicious previous finding. I think that the hospital is liable to write off the cost versus the insurance company.
What a coincidence to see this today–I just dealt with this same thing! When I went for my mammogram, the women at the front desk asked if I wanted the 3-D. I said I just planned to get what my Gyn. doctor had called for. They said, “Oh, this is new and it’s so much better.” I had read a little about it and was interested. Then they gave me a paper to sign that said it might not be covered by my insurance and they estimated the cost to me would be $50. I signed that I’d been warned about that.
Well, a month later, I get the bill for the entire amount of the 3-D, $240! I called the billing office and told my story (and I had the $50 notice paper in my hand–miraculously, I had saved it!). I was prepared to argue, but the clerk on the phone just said, “Oh, that’s a billing error. We’re doing it for $50 as an introductory rate, since it’s new. You’ll get a new bill for $50.” And that’s that.
But what if I hadn’t called?? I’m sure they would have been quite happy to accept my $240! And whoever heard of an “introductory offer” for a new medical procedure?
When I made the appointment, I was asked which I preferred–the traditional mammogram or the higher tech one and I chose the traditional one, since I’m NOT high risk. It seems you SHOULD have been asked and given a choice. I’d work with the hospital/center where you got the test and complain.
I wanted the 3D and had to sign a paper acknowledging that the amount not covered by insurance could be as high as $66. In the event, it was $33 which I was happy to pay.
A tiny nitpick about the title of this thread – you’re talking about screening mammograms, not preventative. Mammograms don’t prevent anything. And they’re not that great at screening either, but they’re all we have.
I filed an appeal months ago as my prescription/referral always called for mammo plus sonogram for one breast which is dense. This is what I am scheduled for annually. This year after the mammo, the technician did two sonograms and I did sit up and question her, and she replied that was what she was doing. There isn’t any charge or co-pay for the mammo, but I did get a bill for a double co-pay for the sonograms. This was for a procedure last July. Originally I thought it was simply a billing error and when I called to check I was told a copay for each scan, but since I thought I was only supposed to have one scan, I protested and said that I should not have to pay a copay for a scan that was not prescribed. The appeal was filed in November after numerous phone calls back and forth and being told to expect an adjusted bill which was never received to a supervisor calling me back within an hour which never happened. I can easily pay for both but I still don’t believe I should have to and so I filed an appeal. Have heard nothing since from my insurance company or from the billing company for the radiologist office either.
@woodsmom . Thanks for posting. I don’t have an answer but I know what to look for when I get mine done.
People like to complain about insurance companies and their policies, but reading these stories it confirms for me my long held belief that the hospitals are just as bad in their billing policies. What they charge and try to get away with sometimes in terms of overcharges and billing “errors” has always frustrated me. I recommend scrutinizing every transaction carefully as I’ve had so many instances of “errors” that I deem to be shady business practices. I’m sure a lot of folks just pay the bill without questioning it so these billers get away with it.
Before I hit Medicare, I paid $950 or so for regular mammogram. I saw it as a necessity. Last Friday, I did mammogram plus the ultrasound. So, I don’t see $100 or so as a problem. I would have been thrilled to,pay that for so many years. And I do think the better machines can be helpful for diagnosis.
@bookworm Even if you hadn’t hit Medicare, your regular mammogram would have been covered now thanks to Obamacare.
Ya, but not for years, my insurance company cost $1200/month, but barely paid for anything. I was definitely someone who wanted a national insurance policy. I even had to pay for my once a year GYN visit.
@carachel2. I definitely initialed and signed paperwork as instructed, and in hindsight I should have paid more attention to it. I haven’t had any issues before and it all seemed routine. It was a screening mammogram referred by my in-network primary care doctor at an in-network hospital. It never occurred to me that I’d be billed. I haven’t been for about five years. We have a large deductible plan so we generally pay for any sick care fully out of pocket. But the basic physicals and routine screenings have been free (even before ACA). The $100 would not be a big hardship for us, but that isn’t the point. How long can insurance decide that something is experimental and unproven when there are many studies showing a benefit? Why wouldn’t the hospital notify me when I was scheduling that their screening method had a portion that many major insurance companies consider experiment and unproven and won’t cover it? Is it unreasonable to expect basic screening and well care to be 100% covered as required by ACA?
@woodsmom …oh I absolutely agree with you no doubt! Screening tests are supposed to be covered by the ACA. It isn’t fair and it isn’t right. If you have not already, you need to go back and request a copy of all the forms you signed.
I get my mammograms at Solis and the notification for the 3D mammogram is on a completely different sheet of paper and they are very clear about the differences and the cost.
I would be VERY upset if I was charged for this and they had hidden the notification on a form with a bunch of other stuff that one normally initials and doesn’t really read detail by detail.
I’m resurrecting this thread because I have a question.
I just had my routine screening mammogram (all is well, thank goodness). My letter says I had a “digital screening mammogram with CAD and 3D tomosynthesis.” My letter from the radiology center also tells me that Connecticut state law (I’m in CT) “requires that each mammography report provided to a patient includes information about breast density which is determined by the amount of glandular tissue.” My breast density is “extremely dense.” The letter goes on to say that "the Law also states that ‘If your mammogram demonstrates that you have dense breast tissue, which could kide small abnormalities, you might benefit from supplementary tests, which can include a breast ultrasound screening or a breast MRI examination, or both, depending on your individual risk factors.’ "
Putting aside the issue of what’s covered or not and what I might have to pay for or not, does anyone know anything about these additional procedures? Are they really useful? Should I consider them? I have no history of breast cancer in my family and I’ve never had any cysts or lumps that have required investigation.