BCBS waiver form: not covering annual mammography (help!!)

I scheduled an annual mammogram and the clinic sent me an online scheduling form. But at the end of the form I'm required to sign a "Bluecross waiver form," which explicitly says that the service I'm requesting (mammography) is not covered. Part of the form is attached. (update: wait, seems like I cannot upload an image :/)

The form says: The purpose of this waver form is to inform Empire BlueCross BlueShield members, before they receive a medical service, that the service listed below is non-covered or not medically necessary or experimental/investigational. By signing this form, I, the physician acknowledge and agree that I have explained to the member that the service listed are not a covered service.

I've talked with BCBS over the phone but the agent I've talked with had apparently no idea about what this form is even about. They just repeat that mammogram is 100% covered in my case. But I'm still not feeling comfortable having to sign this form to schedule. The clinic also just repeats that this is probably a general form that's required for any appointment of this type.

Does anyone have a similar experience??? I've got zero results when googling this "BCBS waiver form" too. Very weird in my opinion.

FYI: It's been about 13 months since my last mammogram. The code assigned on the form says it's "screening mammography."

submitted by /u/Pitch_Black_374
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