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A MyBCTeam Member asked a question 💭
Burlington, VT

This may be a rhetorical question, but I'm pretty peeved and generally confused by the fact that I received a $600 bill for my first annual mammogram post BC. Why does insurance cover annual mammograms pre-BC, but post-BC (when in my opinion it is even MORE important) they won't??? Has anyone challenged this with your insurance company? Has anyone gotten insurance to cover??

thanks for any insight and help, Sue

April 11, 2021
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A MyBCTeam Member

Yes, please do- I just got a call from the hospital to reschedule my bone density test- it was scheduled 3 days shy of the 2 year mark, so insurance would not cover it- so it is now rescheduled for July. Crazy the hoops we have to jump through sometimes!

June 28, 2021
A MyBCTeam Member

I had diagnostic mammograms for several years before breast cancer, and they were always covered by insurance except for a small co pay. My doc ordered them because I was almost always getting called back for cysts and dense breasts, so it got to the point where I just started with a diagnostic mammogram. So, some insurance definitely does cover diagnostic mammogram, and it seems odd that yours wouldn't, esp after breast cancer. I'd say call your insurance and ask for an explanation. You can always appeal. Or, some employers have a patient advocate service that will appeal on your behalf.

April 11, 2021
A MyBCTeam Member

I’m almost 6 years out and my insurance covers 1 yearly 3D mammogram.
Is it possible that it was not yet another insurance year since your last?

Also, what type of mammogram did you have? Was it a diagnostic mammogram? A 3D mammogram? Or just a regular mammogram? Most insurance companies are covering one 3D mammogram per year, but my doctor’s office always has me check prior to make sure it will be covered. A diagnostic mammogram is generally NOT covered by insurance ( which I think is completely wrong - BC survivors should have the immediate availability to have their mammograms read and have further, immediate ultrasound if necessary, which is what a diagnostic mammogram is).

Also, in my experience, sometimes the way your provider codes the exam causes it not to be covered. Have you asked your insurance company why it wasn’t covered? It may be a matter of your provider recoding and resubmitting.

You deserve to know why it wasn’t covered.

I encourage you to make some phone calls. I do believe it’s Federal US Law that 1 standard mammogram per year is covered.

Here’s to finding more answers! It’s sad we have to be so proactive on things like this!

Sending hugs!

April 11, 2021
A MyBCTeam Member

Yes I had to pay that too. Not right at all.

April 11, 2021
A MyBCTeam Member

I get a second mammogram in September, pray my insurance take care of it.

June 29, 2021

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