fairfarmhand Posted May 3, 2011 Share Posted May 3, 2011 This is another one of those "WHAT IN THE WORLD!!!" moments that I have had with our insurance company. I found a lump a month or 2 back and had a mammogram. Got a bill last week for a portion of the bill. Called the insurance company to learn that they don't pay 100% of a diagnostic mammogram. They only pay for mammogram screenings...:001_huh: So if I was over 40 and having a mammogram EVERY year they would pay 100%? But I find a knot and want to make sure it is not cancer they don't pay all of it? Quote Link to comment Share on other sites More sharing options...
Brilliant Posted May 3, 2011 Share Posted May 3, 2011 Yes, I found the rules to be crazy as well. But I am truly grateful that I HAVE health insurance - it will save me at least $80,000 this year for treatment of a small garden-variety breast cancer. I think we'd be filing bankruptcy without it. I hope your diagnostic mammo came back clear! Quote Link to comment Share on other sites More sharing options...
Parrothead Posted May 3, 2011 Share Posted May 3, 2011 Yup, it is that same mentality that says the document I use to show citizenship for Customs is not good enough to show citizenship for the DMV. Blows my mind. Quote Link to comment Share on other sites More sharing options...
tex-mex Posted May 3, 2011 Share Posted May 3, 2011 This is another one of those "WHAT IN THE WORLD!!!" moments that I have had with our insurance company. I found a lump a month or 2 back and had a mammogram. Got a bill last week for a portion of the bill. Called the insurance company to learn that they don't pay 100% of a diagnostic mammogram. They only pay for mammogram screenings...:001_huh: So if I was over 40 and having a mammogram EVERY year they would pay 100%? But I find a knot and want to make sure it is not cancer they don't pay all of it? Bingo. Same exam, different billing code based on the person who processed the bill. BTDT. Crazy. Quote Link to comment Share on other sites More sharing options...
Mommyof4ks Posted May 3, 2011 Share Posted May 3, 2011 Yes, my favorite so far is that my ins. pays for my pap test, but if I want the results then I have to pay to get it read lol. I am thankful for insurance though. Quote Link to comment Share on other sites More sharing options...
In2why Posted May 4, 2011 Share Posted May 4, 2011 This is another one of those "WHAT IN THE WORLD!!!" moments that I have had with our insurance company. I found a lump a month or 2 back and had a mammogram. Got a bill last week for a portion of the bill. Called the insurance company to learn that they don't pay 100% of a diagnostic mammogram. They only pay for mammogram screenings...:001_huh: So if I was over 40 and having a mammogram EVERY year they would pay 100%? But I find a knot and want to make sure it is not cancer they don't pay all of it? Yeppers....this was my same response and reaction last year. I was incredulous that they paid for the initial mammogram and they would pay for Cancer treatments if it was cancer, but they didn't pay for the follow up mammogram when something came back suspicious. I actually asked the lady on the phone what would happen if I couldn't afford the $500 and just waited until the cancer progressed to the point that I was covered and it cost the insurance company double of triple. I really felt a flabbergasted at the idea that while we could afford it, there are so many women out there that might choose not to go back because they couldn't. It is also time for my next screening and I think I am going to take a marker to my breast and mark the exact area there was a problem last time and tell the technician to make sure that she gets what she needs the first time because I am NOT going to pay for a more indepth follow up every year for the same exact lump. :001_smile: Quote Link to comment Share on other sites More sharing options...
Donna Posted May 4, 2011 Share Posted May 4, 2011 Yes, I deal with insurance companies and their craziness often. I had a patient (2yo with numerous surgeries on her hips and feet) who was also getting private PT through her insurance company. She was allowed a certain number of visits a year but the company would only approve 4 at a time so that took care of 2 weeks of therapy then the therapist had to write a letter to the company so they would approve more but they wouldn't approve them immediately so she'd miss 2 weeks of therapy in between approved visits. In this way, she never got in all her approved visits each year....they made it impossible. In my personal experience, dd was born early but two days too late to be eligible to get the shots to prevent RSV. The doctor tried to get the shots approved (cost $2000 a shot and are gotten every month through RSV season) because she had breathing issues and was on an apnea monitor for 4 months but to no avail. So...since she was around her brothers who were around lots of other kids, she ended up with RSV at 5 months and again at 19 months...both requiring hospitalizations for a week due to pneumonia, nebulizer treatments throughout her 1st 4 years (which they had to purchase the machine for) and even now when she gets sick, and lots of doctor visits....I guess their gamble didn't pay off for them. Quote Link to comment Share on other sites More sharing options...
Slartibartfast Posted May 4, 2011 Share Posted May 4, 2011 That is nuts. What sort of insurance is that and did you talk to a supervisor? Quote Link to comment Share on other sites More sharing options...
Maverick_Mom Posted May 4, 2011 Share Posted May 4, 2011 I always thought it was absurd that the insurance company would pay for bloodwork to be processed through a lab -- but they would not pay for the lab technician to draw the blood to begin with. Guess I should've tried to save money by using a household implement to draw my own blood and then just bringing it to the lab myself. :D Quote Link to comment Share on other sites More sharing options...
Maverick_Mom Posted May 4, 2011 Share Posted May 4, 2011 Yup, it is that same mentality that says the document I use to show citizenship for Customs is not good enough to show citizenship for the DMV. Blows my mind. The DMV is unbelievable. They want everything but DNA samples if you conduct a transaction in person, but you can go home and conduct the same transaction on your computer in 30 seconds, few or no questions asked. Quote Link to comment Share on other sites More sharing options...
MrsBasil Posted May 4, 2011 Share Posted May 4, 2011 We routinely went to a walk in family practice clinic that had an xray on site. It was always paid as part of our care. They'd do the xrays and a preliminary read, before sending them to a radiologist. We never had any problems with care or diagnosis. After a few visits for various things relating to my husbands ankle, foot, and toe over a 5 year period(literally 3-4 visits total) they sent us a letter suggesting that we go to a different clinic(run by the company that runs our hospital) for injury because it had a radiologist on site. I called the clinic, they did do xrays, they did have a radiologist, so my DH went there for his last visit. The xray was on a different floor and considered part of the hospital, not the clinic. All the xrays and reading them are were not considered part of the clinic visit and now had to be paid out of pocket as part of our deductible. :banghead: We tried to dispute it, but because of the billing code they use to bill xrays, it's our responsibility. :grouphug: All that to say, I totally empathize. :grouphug: Quote Link to comment Share on other sites More sharing options...
fhjmom Posted May 4, 2011 Share Posted May 4, 2011 Insurance is insane and what they will/will not pay makes no sense. If or my daughters I were just a tad bit more deaf, they would pay $80,000 for a cochlear implant, but they won't pay the $6,000 for hearing aids. :P Quote Link to comment Share on other sites More sharing options...
fairfarmhand Posted May 4, 2011 Author Share Posted May 4, 2011 I hope your diagnostic mammo came back clear! yep..it did. I am fine. Quote Link to comment Share on other sites More sharing options...
Parrothead Posted May 4, 2011 Share Posted May 4, 2011 yep..it did. I am fine. Glad to hear that. Quote Link to comment Share on other sites More sharing options...
ReneTL Posted May 4, 2011 Share Posted May 4, 2011 I'm on hold right now trying to get the lab not to put my account into collections. My Dr. didn't code an annual physical as screening. That was back in August and I can't tell you how much of a headache this has been. In this case it's the dr's office, not the insurance. I don't know why they bother taking a copy of your card if they aren't going to pay attention to how your plan works! :glare: I feel your pain. Quote Link to comment Share on other sites More sharing options...
Kim in Appalachia Posted May 4, 2011 Share Posted May 4, 2011 Mine doesn't pay for it at all, nothing. They don't cover any screenings of any type. If I want one, I have to foot the whole bill. Insurance companies stink. Quote Link to comment Share on other sites More sharing options...
JudoMom Posted May 4, 2011 Share Posted May 4, 2011 This is another one of those "WHAT IN THE WORLD!!!" moments that I have had with our insurance company. I found a lump a month or 2 back and had a mammogram. Got a bill last week for a portion of the bill. Called the insurance company to learn that they don't pay 100% of a diagnostic mammogram. They only pay for mammogram screenings...:001_huh: So if I was over 40 and having a mammogram EVERY year they would pay 100%? But I find a knot and want to make sure it is not cancer they don't pay all of it? Yeah--we have 100% x-ray coverage. However, we found out that they only cover x-rays 100% if they are scheduled. So if your son breaks his arm and they do an x-ray without it being scheduled, they only cover a portion. When I asked the lady to explain why I was reading 100% x-ray coverage on my online account, she offered to refer me to IT support. I told her never mind, I would just make sure I scheduled the next broken bone in advance :glare:. Quote Link to comment Share on other sites More sharing options...
J-rap Posted May 4, 2011 Share Posted May 4, 2011 Can you fight it? This same thing happened to me. Was your diagnostic mammogram at about the same time that your regular annual mammogram would have been anyway? If so, then I would for sure fight it. This is what I did. I wrote them a long letter/claim dispute, explaining that whether I had a lump or not, THIS WAS MY ANNUAL MAMMOGRAM. I also got back to the clinic, and explained the situation. They agreed to change the way it had been billed, and resubmitted it. In the end, insurance paid it. It certainly is frustrating. Quote Link to comment Share on other sites More sharing options...
fairfarmhand Posted May 4, 2011 Author Share Posted May 4, 2011 Yeah--we have 100% x-ray coverage. However, we found out that they only cover x-rays 100% if they are scheduled. So if your son breaks his arm and they do an x-ray without it being scheduled, they only cover a portion. When I asked the lady to explain why I was reading 100% x-ray coverage on my online account, she offered to refer me to IT support. I told her never mind, I would just make sure I scheduled the next broken bone in advance :glare:. I know it is not the fault of the person on the phone.. but things like that are SO ridiculous. Yesterday I told the woman on the phone that I don't go out and get mammograms for the pure joy of it. My friend had a whose baby had to be helmeted to keep her little head from growing funny. insurance wouldn't pay any of that, (it was cosmetic) but if they waited till it became a medical issue, because her skull would be pressing on her brain, then insurance would pay. Quote Link to comment Share on other sites More sharing options...
fairfarmhand Posted May 4, 2011 Author Share Posted May 4, 2011 Can you fight it? This same thing happened to me. Was your diagnostic mammogram at about the same time that your regular annual mammogram would have been anyway? If so, then I would for sure fight it. This is what I did. I wrote them a long letter/claim dispute, explaining that whether I had a lump or not, THIS WAS MY ANNUAL MAMMOGRAM.I also got back to the clinic, and explained the situation. They agreed to change the way it had been billed, and resubmitted it. In the end, insurance paid it. It certainly is frustrating. i don;t get an annual mammogram yet because I am only 31! Quote Link to comment Share on other sites More sharing options...
Lisa in Jax Posted May 4, 2011 Share Posted May 4, 2011 He was referred by our family physician to a GI. After an exam, he was told he needed for a colonoscopy to determine the cause of his gut pain. When we called to get approval for the procedure, the doctor's office said that the insurance company refused to cover the procedure because he is under 50. I called Aetna and said, "So you'll cover a screening colonoscopy at age 50 w/o any indications of illness, but if a gastroenterologist orders the same test due to SYMPTOMS, it's not covered?" The GI's office also called, and eventually, they agreed to pay. UGH! Lisa Quote Link to comment Share on other sites More sharing options...
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