So... my funbags continue to provide me with hours of "entertainment". Get this... the benefits summary of my health insurance plan states that it covers "Preventive Mammography (within recognized standard guidelines)" at 100% with no deductible. And yet, they are denying coverage of the annual mammogram I had in July because it was a "diagnostic" mammogram and not a "screening" mammogram. WTF???? Seriously? Damn insurance company bastards!
Nowhere in any of the materials that I can find does it say diagnostic mammograms are not included. Any reasonable person would infer that one annual mammogram, regardless of how it's coded when billed, would be covered, right? Every annual mammogram I've had until now has always been covered as part of the 100% pre-deductible preventive care stuff, and they've been "diagnostic" for at least the past five or six years thanks to my dense breast tissue, cysts and family history. This is the first time I've run into this situation, and it stinks.
This is a new insurance company for me since my employer seems to change plans almost every year trying to save money. Fortunately, although I have $5,000 deductible, my employer generously covers a large percentage of it, so this mammogram will ultimately end up on their dime. But what about women who's employers don't help out with deductible costs? What happens when they go in for their annual mammogram, thinking it's covered under their preventive package, and then get stuck with a $400+ bill? If their budget is much tighter than mine, it would be difficult for them to come up with the funds to pay it. And it would probably lead to many women skipping this life-saving preventive tool! It's just not right, I tell ya. I won't mention this craptacular insurance company's name, but I will tell you that it rhymes with "oven tree".
The billing department at the facility where I had my mammogram done said they're seeing this situation more often. I did some quick Google research this afternoon, and learned that some companies do not make a distinction between "diagnostic" and "screening" mammograms... both are covered at 100% pre-deductible as part of their preventive packages. Kudos to those companies! That's the way it SHOULD be done. A mammogram is preventive regardless of whether it's diagnostic or simple screening, and it should be covered as part of any pre-deductible preventive package that includes mammography.
I've gotten nowhere arguing this point with my S.O.B. insurance company, but a customer service manager there DID suggest that I file a grievance/appeal, which I will do. I also contacted every local network media outlet today and suggested they look into this situation, since October and Breast Cancer Awareness Month is coming to a close in a week. I doubt any of them actually will, but I hope they do because I really think women need to be aware of it.
It's wrong, wrong WRONG! Well, I think so anyway. But maybe it's just me.
Ladies, don't let it keep you from getting your annual mammogram... most of you won't be getting the "diagnostic" version anyway, but just be aware of it. Check your benefits coverage, and work with your healthcare provider to try and avoid these *%&@# insurance issues. Take care of your boobies!