A couple of years ago, providers started assigning different codes to mammograms. For decades we have been given annual mammograms as covered expenses under all medical policies.No longer is that the case. Under the rules of Medicare, the expense is only covered every other year unless you are considered “at risk”.Those patients are covered annually or at least they were.
Now a mammogram may be coded as either”preventative “ or as “diagnostic “.Insurance coverage covers preventative but diagnostic carries costs.As a breast cancer survivor, I personally find this practice discriminating. I am always looking for the cancer to return and was assured back in 2001, my mammograms would be covered under insurance for the rest of my life as surviving cancer classifies me as “at risk”.
When I received a bill for the testing, I inquired into the charge to my insurance company who indicated that the provider change the code to preventative and insurance would pay. I called my provider with the request “change the code as neither I nor the insurance company are paying for this diagnostic one”.
Colonoscopies have followed the mammogram model. Now there are two different codes which can be applied. Insurance still covers preventative but there will be costs for diagnostic codes.
My husband's father and uncle both died from colon cancer. After many years of asking, my husband finally agreed to have the test. When I received a bill for this service, I called the billing number on the invoice and requested theyrecode the services and present those codes to Medicare.
Unfortunately we have to be our own best advocates when it comes to healthcare. Don’t just blindly assume all bills are correct and need to be paid. Question those costs!Since Obamacare, providers are becoming very creative in supplementing the revenue lost to the 40% restriction instituted on the administration costs imposed with that legislature.