Help...insurance did not pay for my mammo

I had a mammogram on July 9th. i just got a bill from my doctor office for $340.00 saying the patient is responsible for the whole amount. WHo do I call to get this bill resubmitted? The inusrance company or the doctor's office. I have never had this happened to me and I am not sure why the insurance company did not pay it. They paid it last year. I am so worried about having to pay this.

Oh and a few weeks ago, we got in the mail a form to fill out that was asking us if I had any other insurance policy. (this was from our insurance com) My DH provides the insurance so I am a dependent under his insurance. I just filled it out and sent it back....now I am worried something is wrong.


edited for spelling

Message edited 8/30/2008 5:44:56 PM.

Re: Help...insurance did not pay for my mammo

Call the insurance company to find out if the doctor submitted it, and if they did, why did they not cover the test.

They might just have messed up filling out the paperwork. I'm going thru this now with 800 dollars worth of bloodwork.

Re: Help...insurance did not pay for my mammo

Thanks!! I am going to take all my info to work on Tuesday and hope I can find the time to call. I know people go through this all the time. I have never had to resubmitt or question anything becasue the insurance company has always paid.

Re: Help...insurance did not pay for my mammo

You can also check online; most insuranced companies have pretty good websites where you can see the medical claims and explanation of benefits forms for your account.

Good Luck.

Re: Help...insurance did not pay for my mammo

Also, depending on your age (if you're under age 40), some companies won't cover it. however, if there is a medical reason you're having them if you're under 40, get your dcotor to submit that to the company.

also, are you sure this is the doctor's bill?. it may be the radiologist's bill. for a mammo. you are first billed for the actual procedure (radiologist). then you are billed for the professional interpretation (doctor).

Re: Help...insurance did not pay for my mammo

does the bill say the insurance company denied it? sometimes doctors send these out automatically after a certain amount of time, and maybe your insurance just didnt pay it yet.

I get them ALL the time, call the doctor and ask them to submit it to your insurance, 9 out of 10 times they will tell you to disregard the bill for now.

Re: Help...insurance did not pay for my mammo

I would just call and not panic

I go thru stuff like this weekly

I just got a bill from LIJ- again- that every time I call they tell me to rip it up

I swear it's my second full time job

Re: Help...insurance did not pay for my mammo

The paperwok you sent back mayhave crossed in the mail. And all claims will deny in the meantime.

Call the insurance company when they open Tues.

They will tell exactly what happened.

Re: Help...insurance did not pay for my mammo

Thanks for all your responses. It makes me feel a lot calmer. I did make a copy of the paper my insurance company sent in hte middle of August and they send they would pay the doctor once I signed and returned. So I am thinking this will be taken care of, but still plan on calling Tuesday, anyways.

As far as the poster who responsed to me. I am 41 but have been having mammograms since I was 36 and the insurance has always paid for it. But my mom had breast cancer when I was 35 and that is why I have always gotten a mammo since then.

There was nothing on the bill from the medical group saying my insurance denied it. So, I am hopeful that this will clear itself up. Thanks!!

Re: Help...insurance did not pay for my mammo

Re: Help...insurance did not pay for my mammo

Sometimes the insurance company screws up and thinkks the doctor is either not in the network, or it's a doctor that gets partial coverage.

Happened to me once. My primary doctor is in the network, but the "office" isn't. So one time the insurance thought the claim came from the office and not the doctor himself.

Insurance didn't pay and it was a PITA as I had to call them a number of times, but it eventually got corrected.

Re: Help...insurance did not pay for my mammo

If they ultimately don't cover it then call your doctor and let them know the insurance denied the claim and ask them if they'd be willing to adjust your bill. I'm going through this right now with an anesthesiologist and they are the ones that suggested making an adjustment if the insurance would not accept the claim.

Also, most insurance companies allow you to appeal the claim so you can always go back to them and ask what the appeal process is.

Re: Help...insurance did not pay for my mammo

I would call the insurance company first and find out why it was not covered. This happened to me with my annual once and it had to do with the code used by the doctors office. Its a pretty common mix-up and its easy to correct. Hopefully this will be the case for you.

Re: Help...insurance did not pay for my mammo

My insurance won't cover it being it is done through a hospital. You have to pay the co-pay of the hospital.

Re: Help...insurance did not pay for my mammo

Well, I called the insurance company....never spoke to a person directly but said that the claim was indeed processed.....so I am just waiting for a new bill from the doctor's office who basically blew me off and told me to call my insurance. SO, this week I will recall the insurance agency. I think that everything just crossed in the mail and it should get straightened out. Thanks for all of your support, in the meantime.

Re: Help...insurance did not pay for my mammo

Some insurance say you have to be either a year to the date or after your last years mammo, otherwise they wont cover it, unless you went with a problem (like palpable lump, pain etc.)