Cypress
9-5-13, 3:21pm
My insurance plan has a $500 deductible.
I have a benign growth (calcium deposits) in my right breast that the Dr. requested needs a closer look in mammography. The billing is coded as diagnostic and I end up getting a majority of the bill. It is not billed as an annual mammogram.
Last year, I successfully argued that this is a covered service, medically necessary, a mammogram and the cost should not be passed on to me. That decision was in my favor. This year, the grievance was denied. Same insurance company. They sent a copy of last year's grievance and said they would only do this one time as a courtesy to me.
Can I take this complaint somewhere else? The denial of coverage gave a place to appeal, but I am reluctant to follow the insurance company recommendation. They do not want to pay. I don’t want to pay. But, have sent $25 in towards a gross amount of $350.00.
I have a benign growth (calcium deposits) in my right breast that the Dr. requested needs a closer look in mammography. The billing is coded as diagnostic and I end up getting a majority of the bill. It is not billed as an annual mammogram.
Last year, I successfully argued that this is a covered service, medically necessary, a mammogram and the cost should not be passed on to me. That decision was in my favor. This year, the grievance was denied. Same insurance company. They sent a copy of last year's grievance and said they would only do this one time as a courtesy to me.
Can I take this complaint somewhere else? The denial of coverage gave a place to appeal, but I am reluctant to follow the insurance company recommendation. They do not want to pay. I don’t want to pay. But, have sent $25 in towards a gross amount of $350.00.