My wife has to get a mammogram twice a year because of fibrous cysts in her breasts. My insurance will only pay for one yearly exam. Her physician orders the second exam just as a caution. The bill for her recent second mammogram screening is for $546! What can I do???
HealthCue: Chances are if you call your insurance company about this charge they would tell you that the $546 is to be applied to your deductible. If so, that is a fair answer. However, there is something more you can do. All third party payors (an industry term for your health plan) have a process by which patients can appeal denials of payment. Your health plan probably denied this claim because it is standard for women to have only one mammogram per year. Because your wife’s physician wants her to do two per year as a precaution, you can appeal this denial to your health plan stating that the procedure is "medically necessary" in her case, as stated by her physician. If possible, have her physician write a letter stating that the second mammogram is medically necessary and send it in with your appeal. If the Appeals Board approves the claim, the health plan should cover the bill, subject to your deductibles and co-insurance limits.
I recently moved to Charlotte, NC from New England. Prior to my move my physician recommended I have arthroscopic surgery on my knee, an elective surgical procedure. She was unable to give me any advice on physicians or hospitals in the Charlotte area and it was therefore left up to me to figure out who I should see and what hospital I should use. I know her specialty so I thought if I could find out what hospitals did this surgical procedure well it might lead me to a superior physician in her specialty. How do I find out about hospitals in Charlotte?
HealthCue: There are a number of websites that contain information about the quality of hospitals. If you Google “hospital quality” or “hospital compare,” you will be led to a number of websites that have data about hospital quality and in some cases, prices for procedures. A good starting point may be www.hospitalcompare.hhs.gov. This is the Medicare website that compares hospitals on the basis of quality measures. It also has a checklist of questions to consider before going to the hospital and a section on you rights as well. This issue has been in the news lately and the next column of HealthCue will cover additional questions raised by your inquiry.
