If you know a woman who has received a breast cancer diagnosis, you might want to alert her to this issue. It is a very common problem.
Per my insurance contract with Aetna, I am supposed to get one free mammogram a year. I have never asked for more than one mammogram a year, except the year I was diagnosed with breast cancer. This is the second year Aetna has denied payment and the billing agent for my doctor's office told me EVERY insurance company follows this procedure. Think of the irony, a woman has had cancer and her insurance company doesn't encourage her to have a yearly check up. What a crock...
My insurance company, Aetna, will NOT pay for my once a year mammogram because my doctor does not bill the costs as a “routine diagnosis”. Instead, my doctor bills the costs as a “medical diagnosis” because he has treated me for breast cancer. I was told by his billing agent that the coding “routine diagnosis” can only be used for patients who have never been diagnosed with cancer. So my doctor has no alternative. ?? I understand this coding interpretation is a very common practice.
Women who have been diagnosed with breast cancer are already frightened and naturally cautious. However, the menace of medical coding prevents many of us from our rightful contract obligations. All the while the insurance company can hide behind the official way of doing something.
I was able to pay for my mammogram, this year (and last year too btw) and I am thankful for that. I hope Congress will address this coding problem in the health care debate. It is not fair for me and this situation is even more unfair for those women who can not afford to pay for a yearly mammogram - after they have been diagnosed with breast cancer.
It just isn't right so I wrote to my members of Congress.
