7+ month fight ongoing to get my wife’s first 40+ mammogram covered
my wife turned 40 in september and went for her well woman visit shortly thereafter. they scheduled her for her first mammogram since she was now over 40. that appointment was in november. that's where this hell began. first bit of background is that we're in CA and our insurance is a HDHP with anthem.
first, the imaging center wouldn't even see her until she paid a $600 charge that they said was attributed to our deductible. when she questioned that as a mammogram should be covered over 40, they strong armed her into paying it and she reluctantly agreed because it took weeks to get the appointment in the first place and she didn't want to give up the appointment and have to reschedule (again, they would not even take her back until she gave them a credit card).
when she got home, we started calling around to figure out exactly what was going on. we eventually figured out that the doctor apparently coded it wrong when sending it to the imaging center, and that was the reason it wasn't fully covered when she went to get the mammogram done. no big deal, right? that happens all the time (including several times in the past few years for me with my yearly labs related to my physical). doc says no problem, we'll resubmit with the correct code (as they always have for me without issue) and then the imaging center can re-submit as well and get it covered and get a reimbursement.
here's where the real fun starts: the imaging center refuses to allow them to re-code it. they say "that's illegal," which is obviously bullshit.
wife tries to call the imaging center herself. they tell HER that it's illegal to re-code or re-submit. nothing they can do, you're SOL. thanks for giving us your money. oh, and now there's another $115 charge that they are billing us for, for which we still haven't been able to get an answer as to what the fuck this is. now we're talking about $700+ for something that should be covered at 100% for women over 40.
wife is stressed out now and just wants to pay it to get this over with, which i absolutely refuse to do on principle at this point. i pay my premiums every god damn month, i'm not paying for something else on top of that which should absolutely be covered. the doc suggests calling anthem and having them do a three way call with the imaging center. again, they refuse to allow re-coding it or re-submitting it.
anthem then says we can file a grievance, which we agree to do because we're not sure where else to go or what else to do at this point to get this covered. we just got a letter back today that we didn't submit the grievance in time, so anthem won't even entertain it. which is also super convenient, because the initial call with them was absolutely within the first six months but they then sent us a letter 3 weeks later that required us to fill out a form and send it in to process the grievance. sure as hell feels like they intentionally dicked us around long enough to run out the clock on that 180 days.
i'm so over the stupid as fuck healthcare system in this country at this point, and my wife is now refusing to ever go back for any further care which is also stressing me out because i'm paying for our health insurance to try to keep us both healthy as we get older.
can anyone suggest where we should go from here to get this covered?
submitted by /u/matty8199
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