Wellness

[KALLIE]

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@hoosieroriginal wrote:

I feel the mammographer should tell you if it is not covered by your insurance.  I had a mammogram ordered by dr because I found a lump and because it was a "special" mammogram, my insurance did not cover it.  I was absolutely furious and said they should have told me that before I had the mammogram.  They are now getting $20/mo to pay it off - they can wait for their money!

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The mammographer has NOTHING to do with knowing what insurance companies cover. It is the patient's RESPONSIBILITY to check on whether or not the facility accepts her insurance before having any procedure done.

[KALLIE]

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@151949 wrote:

I had a mammogram this morning - as if that isn't a bad enough way to start the day , as I was leaving the receptionist calls me over to say I should check with my insurance because they may no longer be "In network" with my insurance. My heart fell to my stomach! OMG - how much is this going to cost? I got home and called my ins co and they said the center was no longer in their network but that they had a legal responsibilioty to inform me of that before the test was done, not after. She said I will get a letter denying the coverage then I can call and my ins co will fight with the radiology center and make them do it free because they had a responsibility to notify me they were no longer in network. What a pain in the neck ! I feel certain that receptionist looked up my insurance and knew while I was sitting in the waiting room it would not be paid for. There was only me and a couple other people there , so they were not busy. 

I'm mad at myself too for assuming that just because they have been in network for the past 5 years that they still are - I'm usually so careful about stuff like this.

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Highly doubtful.

[lulu2]

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@Scooby Doo wrote:

Since I am covered by Medicare it doesn't matter where I go to get a mammogram.  Medicare pays for it once a year, and my secondary insurance is not billed.

I went on Medicare in December.  It was my understanding they'd pay for my annual mammogram.

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[151949]

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@lulu2 wrote:

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@Scooby Doo wrote:

Since I am covered by Medicare it doesn't matter where I go to get a mammogram.  Medicare pays for it once a year, and my secondary insurance is not billed.

I went on Medicare in December.  It was my understanding they'd pay for my annual mammogram.

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if you have medicare and a supplement you can go anywhere that accepts medicare and have a mammogram  once a year for free, but if you have an advantage plan they are generally either an HMO or a PPO so you have to stay in network or pay (literally) the consequences.

[kcladyz]

Also with hospitals. When you file a claim it is done at out of network rates even if it is a in network hospital. 

[CelticCrafter]

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@151949 wrote:

if you have a PPO you can go out of network and they pay it but I have an HMO and they do not pay anything for out of network.NOTHING.

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With a PPO you can go out of network however, if the PPO only allows $100 for a test and the charge is $200 you are responsible for the difference.

[Nuttmeg]

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@151949 wrote:

if you have a PPO you can go out of network and they pay it but I have an HMO and they do not pay anything for out of network.NOTHING.

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I have a PPO plan with Medicare. We are warned to be careful to stay in network, because the charges can get very expensive.