When I made my mammogram appointment over a month ago, the provider I was referred to by my OB-GYN had an online portal that had you fill out the usual paperwork in advance online, so I was able to do things like upload my driver’s license, front and back of my insurance card, and fill out any personal and family history ahead of time. What it also did was give me an estimate of what my out of pocket cost would be at the time of appointment check-in. This was a rude awakening: it said based on my health insurance that my out of pocket cost should be around $350 for a mammogram and breast ultrasound.
None of this sounded right. Mammograms are standard and covered by pretty much every health insurance for women over 40. Breast ultrasounds are covered in New York state (and apparently… not in Kansas, where a friend of mine lives, and where she had to pay $300 PER breast out of pocket). I called my health insurance, who confirmed to me what I suspected: I should have zero out of pocket costs, no co-pays, for either procedure. They gave me a reference number to give to the provider. I then called the provider, gave them the reference number, but they said they could not tell me the cost until I came into the office, which seemed not only completely inefficient, but just plain stupid. “If you ask me to pay for this out of pocket when I come in, I will decline the procedure and walk out,” I said sternly to them over the phone. “I am asking if you can correct this ahead of time so we don’t waste your time or mine?”
The person on the phone seemed totally unfazed, like she didn’t care (and frankly, probably wasn’t paid enough to care). She told me there was no way to confirm until the day of the appointment when I came in (which seems false the way health insurance works, but whatever). So she told me to just come in, and she doubted I’d have to pay anything out of pocket.
Well, I came in this afternoon, and lo and behold, that same $350 amount showed up as what I owed at the time of service. I insisted to the receptionist I wasn’t paying it. I gave them the reference number once again, and she made a flippant response: “Breast ultrasounds are not typically covered, but okay, we’ll call your insurance.” Her associate called my insurance. Twenty minutes later, they confirmed that I was correct, that I did not owe them any payment… but, I would be required to pay $20 copay for the breast ultrasound.
“Copay – is just for the breast ultrasound?” I said to her, still skeptical. I made a mental note, planning to call my insurance to contest even this amount after I paid it because this still goes against what my health insurance stated to me on the phone, which I wrote down with the reference number.
“Yes, that’s what I said,” the front desk person said, clearly annoyed with me. I’m not sure what her problem was — it wasn’t like she was getting the money. Their office was the one who screwed up, not me.
I paid the copay, then had both the mammogram and breast ultrasound done. I walked out of the office much later than I estimated I would, so the whole experience was pretty frustrating, especially since I tried to prevent foreseeable problems way in advance, which this office obviously thwarted. But this is just one of many stupid, frustrating and senseless examples in my personal experiences of why our healthcare system in the U.S. is so fucked — an example of what not to be. I also made a note to ask my OB-GYN for another radiology provider because I definitely do not want to go back here at all ever, ever again.