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Post by cindyupnorth on Nov 13, 2016 20:38:00 GMT
So like every other yr I have to have my mammo redone, and an US. This was one of those years. My annual Mammo is covered under my insurance plan, BUT if I have to have it redone, for a further look, that is NOT covered. So my other mammo, AND my US are not covered and I end up having to pay for it all, as I usually have not met my deductible. Is this true for everyone else? Or is there something I should be doing to have it recoded and covered? or any advice? Thanks!!
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Post by Yubon Peatlejuice on Nov 13, 2016 20:41:54 GMT
It is the same for me. I don't thing there is such a thing as a "free mammogram". That just gets you in the door. Then they need to run other tests or have you come back in, and that costs you money.
I think it is a huge racket.
I refuse to go every year. Maybe I will go every 3 years. That is more in line with what women in other countries do.
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Nink
Pearl Clutcher
Posts: 4,947 
Location: North Idaho
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Post by Nink on Nov 13, 2016 20:47:46 GMT
So like every other yr I have to have my mammo redone, and an US. This was one of those years. My annual Mammo is covered under my insurance plan, BUT if I have to have it redone, for a further look, that is NOT covered. So my other mammo, AND my US are not covered and I end up having to pay for it all, as I usually have not met my deductible. Is this true for everyone else? Or is there something I should be doing to have it recoded and covered? or any advice? Thanks!! It should be coded differently than a screening mammography. It should be coded as additional views. The CPT code that we use is G0206. |
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Post by cindyupnorth on Nov 13, 2016 20:49:31 GMT
Nink, even for the US?
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Deleted
Posts: 0
Jun 15, 2024 13:38:51 GMT
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Post by Deleted on Nov 13, 2016 20:49:43 GMT
Yes. I was hurried through my first one. Then call back for a second one. Only the first was "free"
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Nink
Pearl Clutcher
Posts: 4,947
Location: North Idaho
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Post by Nink on Nov 13, 2016 20:50:57 GMT
It would be in addition to a breast US code which I can't remember off the top of my head. |
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Nink
Pearl Clutcher
Posts: 4,947
Location: North Idaho
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Post by Nink on Nov 13, 2016 20:54:29 GMT
I should add that mammo code is for digital mammography. It will be different for analog. I'm wondering how your facilities are coding your exams to insurance, as we go to great lengths to make sure the add views are a covered exam for our patients.
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Post by beanbuddymom on Nov 13, 2016 20:56:56 GMT
Yes that has been the way it was for me many, many years and it really pissed me off every time, because $300 out of pocket is a lot of money for me to have to pay. Now I go to a place that reads them right there and doesn't send me on my way until they are done and I am hoping that solves that problem of billing twice.
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Post by cindyupnorth on Nov 13, 2016 21:01:45 GMT
Nink it's digital. They go to 3D next yr. I also have to go again in 6 months, as I have 2 cysts that they don't like. Which I am sure I will be billed..AGAIN. as it only covers 1 mammo a yr. UGH!! I can't afford all of these mammo's. So I need to ask the facility doing the tests, to recode for additional views. Correct?
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Post by Zee on Nov 13, 2016 21:02:00 GMT
It is the same for me. I don't thing there is such a thing as a "free mammogram". That just gets you in the door. Then they need to run other tests or have you come back in, and that costs you money. I think it is a huge racket. I refuse to go every year. Maybe I will go every 3 years. That is more in line with what women in other countries do. I totally agreed with you...until they found cancer. |
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Post by Yubon Peatlejuice on Nov 13, 2016 21:05:59 GMT
It is the same for me. I don't thing there is such a thing as a "free mammogram". That just gets you in the door. Then they need to run other tests or have you come back in, and that costs you money. I think it is a huge racket. I refuse to go every year. Maybe I will go every 3 years. That is more in line with what women in other countries do. I totally agreed with you...until they found cancer. I'm sorry about that, and I realize that is a risk. |
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Post by cindyupnorth on Nov 13, 2016 21:08:28 GMT
Yea, I would skip them too, BUT unfortunately I have these 2 cysts they freak out over every other yr. One has changed in shape. I don't have any family history or anything, but recently, within the last 1 yr. 3!!! of my very closest co-workers have been found with breast cancer, and had to go thru treatments. It's sort of freaky. I don't want to be the 4th.
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Nink
Pearl Clutcher
Posts: 4,947
Location: North Idaho
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Post by Nink on Nov 13, 2016 21:10:53 GMT
Nink it's digital. They go to 3D next yr. I also have to go again in 6 months, as I have 2 cysts that they don't like. Which I am sure I will be billed..AGAIN. as it only covers 1 mammo a yr. UGH!! I can't afford all of these mammo's. So I need to ask the facility doing the tests, to recode for additional views. Correct? Yes. Ask them to make sure they are coding it correctly. And get the number needed to call and see how they will be coding it and if it's not covered ask why. Code G0206 is a diagnostic mammo code. Which is what you're having on call back. If they try and re-bill as an off shoot of a screening mammo (G0202) then it most likely won't be covered. We code it as a separate diagnostic study. Hope that made sense. |
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Post by Zee on Nov 13, 2016 21:12:07 GMT
I totally agreed with you...until they found cancer. I'm sorry about that, and I realize that is a risk. Yeah, it's tough. The most recent biopsy I was all ready to say no thanks, I'm happy to just watch it and see how it goes. No history of any cancer in my family, no symptoms, I felt no real risk. But I kept thinking that IF I had a problem, I'd regret not just doing what was recommended, and my kids are older but they still need a mom. So I'm glad I did. I totally get where you're coming from, though. Most women would be fine waiting, but there's always that risk. |
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Post by cindyupnorth on Nov 13, 2016 21:20:44 GMT
Nink, I usually just email them my questions. It's easier due to my work. Is that just as good? or better to call?
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Post by kristi on Nov 13, 2016 21:26:09 GMT
I don't pay for my every 6 month mammograms or ultrasounds. This year I had to have an MRI in addition to the ultrasound/mammogram & I had to pay $1000 for that out of pocket.
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Post by cindyupnorth on Nov 13, 2016 21:27:45 GMT
Kristi, how do you NOT? ha
NINK, I PMd you!
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Post by scrapmaven on Nov 13, 2016 21:38:43 GMT
Have you discussed the option of removing the cysts now, so that you won't have the risk from them anymore? It is terrible that you have to pay for more scans. This is all necessary stuff. It's a racket. Wishing you normal scans.
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Post by 950nancy on Nov 13, 2016 21:42:16 GMT
It is the same for me. I don't thing there is such a thing as a "free mammogram". That just gets you in the door. Then they need to run other tests or have you come back in, and that costs you money. I think it is a huge racket. I refuse to go every year. Maybe I will go every 3 years. That is more in line with what women in other countries do. I totally agreed with you...until they found cancer. I happily go every year. I have never had to go twice in over 15 years. I had "the little paddles" brought out one time when my boobs were feeling rather fibrous, but that was it. Perhaps with the new machines that they are using that measures every cm things will be better. There are other doctors I prefer to avoid. |
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Post by cindyupnorth on Nov 13, 2016 21:59:55 GMT
Why would I want them removed? they don't bother me? I am sure insurance wouldn't pay for THAT either. HA!!
I am going to talk to my dr when I go for my annual next yr, and ask if the mammo and US can't be my routine. I don't want to do this every yr, go back, and then have to pay for it.
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Post by ntsf on Nov 13, 2016 22:11:27 GMT
I talked to the clinic this year cause I have to be called in twice every time.. they said to try to get doc to request a dx screening.. so you get the 3d the first time..and not called back again. I hate being called back.. had to wait hours and the staff was condescending..
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melissa
Pearl Clutcher
Posts: 3,912
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Post by melissa on Nov 13, 2016 22:22:18 GMT
An annual mammogram is covered as routine preventative screening. Anything beyond that is not routine screening and is covered based on your policy. Coverage for a screening mammogram is currently guaranteed through the ACA.
As far as the suggestion to remove benign cysts... ALL breasts have cysts. That's the nature of breast tissue. Adding a surgical procedure to that mix will then add scar tissue that will also need a second look in the future. Doesn't solve anything.
Having just come back from a major breast cancer think tank, I'll remind anyone that having cancer is a heck of a lot more expensive than a test to rule it out... and then imagine having metastatic cancer which means treatment for the rest of your life. A very different world.
We all complain about health care costs. I had a small surgery this summer and the 6K plus costs pretty much feel under my deductible. I "only" pay $750 a month for my own insurance. Anyway, spending time with a woman who was trying to figure out how to get the 15K medication she needs twice a month to continue fighting her disease put things into perspective for me once again.
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Nink
Pearl Clutcher
Posts: 4,947
Location: North Idaho
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Post by Nink on Nov 13, 2016 22:23:08 GMT
I talked to the clinic this year cause I have to be called in twice every time.. they said to try to get doc to request a dx screening.. so you get the 3d the first time..and not called back again. I hate being called back.. had to wait hours and the staff was condescending.. Where I work you have the option of getting the 3D imaging at your screening. Medicare does cover the 3D Tomos, but other insurances do not. It is a $60 out of pocket payment to get it, but we do it on the first visit. I'm sorry you had that experience. |
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Post by bc2ca on Nov 13, 2016 22:23:09 GMT
A couple of years ago after my regular screening mammo I had to go back for a further look and US. They moved from screening to diagnostic codes IIRC. I didn't have to pay anything extra.
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Post by cindyupnorth on Nov 13, 2016 22:31:33 GMT
Thanks for weighing in Melissa. I am not a big believer in medical procedures unless I need them. They asked if I wanted to biopsy the cysts right away. I was like, what for? Lets see what the 6 mo looks like. I agree, it could be much much worse!! Thanks so much.
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