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I have a high deductible insurance through my husbands job (Empire blue cross) I get a mammogram every year since turning 40 and I have never had to pay for it. I got one last July and I am still paying it off.) The insurance company will not pay anything until our deductible is met. I want to know where there are free screenings for women. I can't afford another $400 bill. I have like 2 more payments left.
I have a high deductible insurance through my husbands job (Empire blue cross) I get a mammogram every year since turning 40 and I have never had to pay for it. I got one last July and I am still paying it off.) The insurance company will not pay anything until our deductible is met. I want to know where there are free screenings for women. I can't afford another $400 bill. I have like 2 more payments left.
I believe, per the Affordable Care Act, that anything preventive in nature is exempt from copay and deductible. Speak to your insurance company and then ask your doctor. They should be able to resubmit the claim with a preventive IDC-9 code, which would entitle you to a refund. You should not have paid a cent.
ACA Requirements for Coverage of Preventive Services Under Section 2713 of the ACA, private health plans must provide coverage for a range of preventive services and may not impose cost-sharing (such as copayments, deductibles, or co-insurance) on patients receiving these services.
My portion that I had to pay was $491.31. Empire negotiated with Good Sam so I could have a lower out of pocket expense. I have already tried and spoke to my insurance Co. They won't budge. Hence my reason for asking for a free mammogram. Once my deductible is reached I won't have to pay for this kind of service. My deductible is $9,000.
My original billed amount was $927. My portion that I had to pay was $491.31. Empire negotiated with Good Sam so I could have a lower out of pocket expense. I have already tried and spoke to my insurance Co. They won't budge. Hence my reason for asking for a free mammogram. Once my deductible is reached I won't have to pay for this kind of service. My deductible is $9,000.
What I'm telling you is that by law, there should not be a co-pay or deductible imposed on this type of service. Ask your insurance company how the claim was coded. I will bet you that Good Sam coded it as diagnostic, which would indeed be subject to your deductible. If they resubmit the claim as preventive (which it should have been) then your deductible will be removed. Empire is generally a breeze to work with compared to others. But they aren't going to do this legwork for you. Trust me. I'm giving you solid advice here. Doctors and hospitals code this stuff wrong all the time. I watch all my claims like a hawk.
That is very high for a mammo. They really shoukd not run more than $200 even if you had to pay out if pocket. Previous posters advice is good; I went where I always go for my mammo this year and even out if network they paid the whole thing. However if you still have issues contact Komen. And when all is said and done $40/month is. It too much to potentially save your life.
Zwanger Pesiri has free mammograms on Give Back Sundays for the uninsured and low income.
I realize it won't help Lubby, but maybe some else could use this program.
That is very high for a mammo. They really shoukd not run more than $200 even if you had to pay out if pocket. Previous posters advice is good; I went where I always go for my mammo this year and even out if network they paid the whole thing. However if you still have issues contact Komen. And when all is said and done $40/month is. It too much to potentially save your life.
It's surprising how many people don't understand their coverages or how the new laws affect them. I have to choose between 5 plans every November, so I made it a point to understand each and every facet of all the policies. Ever see that guy arguing with the receptionist about paying his co-pay? That would be me. I let them bill me later whenever there's doubt. It always amazes me how quick the doctor's office will mail you a bill when the EOB (explanation of benefits) comes back and they realize you were subject to a copay...but those times when you do pay the copay, and the EOB comes back saying you weren't supposed to, they never mail you an apology and a check.
The moral of the story is: know your insurance and know the law. I've gotten bills for diagnostic procedures that were only charged because they were billed incorrectly. Make sure your doctors are coding correctly. A simple IDC-9 code is all it takes to save/cost you hundreds, even thousands of dollars.
In the OP's case, I am 100% sure she should not be paying a copay or subject to her plan's deductible for a preventive mammogram. It was most likely coded wrong and billed accordingly. I'd have the facility re-submit the claim properly and they should also refund the deductible. It is the law, plain and simple.
If you have a preventive mammo that finds something, and the doctor recommends a follow-up in, say, 6 months, that follow-up test would be diagnosticand subject to co-pays/deductibles et al. It's all in the codes. Insurance pays your bills based on them. Pay attention to your EOBs. The insurance company won't.
The thing with a mammo is you have to wait more than a year for it to be coded preventative. If OP went for A mammo on June 30,2014 and then went back June 29,2015 she's going to be out if luck. Insurance companies are very specific and rigid about this.
The thing with a mammo is you have to wait more than a year for it to be coded preventative. If OP went for A mammo on June 30,2014 and then went back June 29,2015 she's going to be out if luck. Insurance companies are very specific and rigid about this.
100% correct....but if she used a different insurance policy the prior year, the first year is a clean slate and establishes that date.....
Yes and either way the place shoukd be aware of that issue. Where I go they schedule next years at the time of this years service and make sure it is at least a year and day later.
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