I went in for my first ever mammogram which is fully covered by my Anthem insurance. I was told by the very nice nurse "Do not get excited if you get a call back because 85% of baseline mammograms get a call back for more images". I thanked her for warning me and sure enough the next day I got a call back. A nice woman informed me that they needed me to come back in for more images of the right breast and she gave me a date to come back about 6 days later. She NEVER mentioned that this would not fall under my insurance-covered mammogram. It absolutely felt like one seamless process. After this 2nd visit which took about 25 minutes of actual physical interaction I was told all was fine after all and nothing showed up. Later I got a bill showing this cost over 2,000 and I was being billed for what my insurance did not pay which was well over $500. Knowing I had a full covered mammogram I thought it was a mistake. I spoke to my insurance and they told me the reason it was not all covered is it was coded as "diagnostic" and they would have covered it in full if coded "preventing". The insurance rep told me to ask the hospital to change the coding. I spent many hours on the phone trying to sort this out and was met with a complete STONE WALL. The hospital manager told me that the "diagnostic" code is set in stone and absolutely cannot be changed to the preventative code.
UPDATE: I also got a robotic collections call out of the blue saying I owed $237 for "Savannah Chatham Imaging" which I have learned is the radioligist who read the scan. The robot call was so sketchy (and no live agents available to ask questions) so I googled the name of it and found it has 13 one star reviews online all about billing. Similar stories of no bill then being sent to collections all over those reviews. I called back to the Telfair Pavilion to verify this is another bill attached to this same fiasco. So my total unexpected out of pocket expense for this routine preventative mammogram is actually $800
I feel like I got tricked into generating a large extra payment for the hospital and I have no idea why communication would be so poor in terms of letting me know up front the additional scan they told me I had to get was not going to fall under the screening mammogram visit. I also feel that the billing department is aggressive and difficult. I got the runaround with billing telling me to call the hospital and the hospital telling me to call billing. In the end nobody would help me with it in any way with changing the code to Preventing so that it would be 100% covered. read more