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Esteemed Contributor
Posts: 6,527
Registered: ‎03-10-2010

Re: Mammograms, Office Wouldn't Do


@cuddlesmama wrote:

My current doctor recently  retired and gave  me a list  of  names of other doctors I could go to. Unfortunately, all of those Dr. had bad reviews when I looked them up. So now I am searching for a new Doctor. Well, it was time for my Mammogram so I called to schedule and when I told her my Dr. retired the office said they couldn't do it unless I had a PCP. This office always sent me the results any way so if I saw I had a problem I could call a specialist. I was so surprised that they flat out refused me. Has anyone else here had this happen to them?


@cuddlesmama  Like I guess everyone else here I need a doctor's order for a mammogram or any kind of test. With the mammogram, the person who reads it finds any problems...it's not up to me. Do you get the films?  Do you actually SEE them?  And usually one needs a referral to see a specialist. 

Did you ever look up your previous doctor?  Hey may not have the best reviews either, even though you thought well of him. Because more people will share a bad experience before they will talk about a good experience. Because we expect good ones...why would we mention that everything was fine?

 

Talk to your friends/relatives and see if they can recommend someone. 

My own experience with asking a doctor in one specialty if he could recommend a doctor in another specialty has not been good...twice. I'm sticking with asking people who have been treated by doctors for recommemdations...not doctors who might have had lunch with them. 

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Posts: 4,696
Registered: ‎03-19-2010

Re: Mammograms, Office Wouldn't Do

@CARMIE the mammograms were eventually paid, but only after I spoke with someone and told them I had no say in who actually read the mammograms.  That was in the beginning of Obamacare and you could actually talk to people back then.  And, I say mammograms because they turned around and did the same thing to me the following year.  Just finding an In-network facility was a problem too.  The contract said you must go to an in-network facility yet there was no way of finding out if a facility was in-network or not.  Nobody at the facility knew and there was no indication at my Insurer's website about it either.  I called Customer Service and the girl that tried o help me apparently only had the same website I was using because she found only the same information I was finding.  I can imagine how much money BCBS made off of women who just paid that bill instead of appealing it.

 

The pap smear appeal was denied because it's the reponsibility of the patient to make sure the doctor sends labs to the correct lab.  It had nothing to do with my deductible.  It was my first time going to this gynecologist and it seems rational to me that if you're going to an in-network doctor that they would send your labs to an in-network lab.  Isn't that part of the requirements to be considered in-network?  If not, it should be.  

 

My ex-husband used to work for an insurance (car) company in claims and I heard many stories about how he worked with lawyers to deny claims from people since they couldn't afford a lawyer to fight a claim.  

 

 

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Registered: ‎08-02-2010

Re: Mammograms, Office Wouldn't Do

@cuddlesmama i do not need PCP recommendation.  As a matter of fact the office where I have my mammogram done sends me a notice and then I call to mak the appointment.

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Registered: ‎03-10-2010

Re: Mammograms, Office Wouldn't Do

With my insurance I do not need a referral to a specialist or any other doctor outside of my PCP.  I have gone to an orthopaedic specialist on my own for an issue I was having and as long as the doctor is in my network, it's fine.  However, when the time comes, my doctor always sends an order to the facility for my mammogram and the facility calls me to set up the test.  The one time I called the facility myself because they hadn't contacted me, one of the first things they asked was who the ordering physician was.  I have no idea what they would have done if I would have said I had no order, it was just time for my mammogram.  

 

I wonder if you could go to one of those mobile mammovans? 

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Re: Mammograms, Office Wouldn't Do


@CARMIE wrote:

@Icegoddess  Insurance companies do not word things to get out of paying for services.  Your benefits are listed clearly.

 

You are responsible for knowing those benefits, and you alone.  You should call the insurance company and ask before you receive services so you don't get any surprises.

 

 

 


@CARMIE, you are correct.  I ran into this several months ago when I found out when reading my contract that our insurance doesn't cover a colonoscopy.  Had I not read that contract, I never would have known that.   

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Registered: ‎10-25-2010

Re: Mammograms, Office Wouldn't Do


@LipstickDiva wrote:

@CARMIE wrote:

@Icegoddess  Insurance companies do not word things to get out of paying for services.  Your benefits are listed clearly.

 

You are responsible for knowing those benefits, and you alone.  You should call the insurance company and ask before you receive services so you don't get any surprises.

 

 

 


@CARMIE, you are correct.  I ran into this several months ago when I found out when reading my contract that our insurance doesn't cover a colonoscopy.  Had I not read that contract, I never would have known that.   


If you ever have symptoms and your doctor orders a colonoscopy as a diagnostic procedure, it is probably covered.

 

Your insurance might not cover a colonoscopy if done as a routine preventative service.

 

It's always good to read and know your benefits before you consent to medical procedures.

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Posts: 3,043
Registered: ‎05-30-2010

Re: Mammograms, Office Wouldn't Do

You're right Carmie, the rules for getting a MD referral for screening mammogram are no longer necessary as of 2019.

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Re: Mammograms, Office Wouldn't Do

[ Edited ]

Saw the other info.  Edit.
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Esteemed Contributor
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Registered: ‎03-10-2010

Re: Mammograms, Office Wouldn't Do

Are referral and order the same thing?  Does no referral needed for screening also mean no order needed for screening?

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Re: Mammograms, Office Wouldn't Do

As a 2x breast cancer survivor, I can't help but wonder.......if you don't have a PCP and don't need a referral for a mammogram, what happens if the mammo shows something and you need a sonogram or a biopsy. Is that the time you want to start running around looking for a PCP and waiting for a new patient visit? Who will send you to a surgeon and do any pre op testing? I know the last time I was diagnosed, it took about a month or so until my surgery was performed and I had all tests and docs ready to go. I can't even imagine having to start the process at that point give the emotional and physical stress a cancer diagnosis causes.


'I refuse to engage in a battle of wits with an unarmed man'.......Unknown