I’m a 42-year-old female resident of Maryland with United Healthcare PPO.
I saw my primary care doctor in December and we spoke about my need to go for a mammogram screening. She had given me a referral for a mammogram the year before but I never used it, and have not had one ever in my life yet. After we discussed this, she examined my breasts and felt a “fullness” in my right breast. She gave me another referral for a mammogram and ultrasound.
I went to another provider for the mammogram and ultrasound services, and everything was fine, the fullness ended up being nothing.
I received a bill in the mail for $458, which I was not expecting. Insurance did not cover any of the screenings as they were considered diagnostic services, rather than preventive, which would have been covered.
I contacted UH who explained this to me, and they suggested I contact the mammogram provider to see if they would re-submit the claim with revised billing codes. I contacted them, and the mammogram provider said I would need to talk to my primary care provider about modifying the codes. I spoke with my primary care doctor and they said they are not legally allowed to change the codes to preventive since the doctor detected a fullness in my breast.
Am I stuck paying this bill, or is there anything I can do at this point? It doesn’t make sense that if the doctor had not felt anything my mammogram would have been 100% covered, but since she did feel something (that ended up being nothing – myself nor my boyfriend felt anything at all) I am being charged.
submitted by /u/headee
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I’m a 42-year-old female resident of Maryland with United Healthcare PPO. I saw my primary care doctor in December and we spoke about my need to go for a mammogram screening. She had given me a referral for a mammogram the year before but I never used it, and have not had one ever in my life yet. After we discussed this, she examined my breasts and felt a “fullness” in my right breast. She gave me another referral for a mammogram and ultrasound. I went to another provider for the mammogram and ultrasound services, and everything was fine, the fullness ended up being nothing. I received a bill in the mail for $458, which I was not expecting. Insurance did not cover any of the screenings as they were considered diagnostic services, rather than preventive, which would have been covered. I contacted UH who explained this to me, and they suggested I contact the mammogram provider to see if they would re-submit the claim with revised billing codes. I contacted them, and the mammogram provider said I would need to talk to my primary care provider about modifying the codes. I spoke with my primary care doctor and they said they are not legally allowed to change the codes to preventive since the doctor detected a fullness in my breast. Am I stuck paying this bill, or is there anything I can do at this point? It doesn’t make sense that if the doctor had not felt anything my mammogram would have been 100% covered, but since she did feel something (that ended up being nothing – myself nor my boyfriend felt anything at all) I am being charged.
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