Question on mammogram deductible: BCBS MA plan through employer while living in NY

Hi all,

My wife has coverage through BCBS MA as of this year. Her new employer is located in MA, she works remotely in NY (employees are based all across the country).

She got her mammogram ultrasound, which she has been getting every year through her NY based doctor (she had Aetna and Cigna in the past). As per NY law, mammogram ultrasounds are considered preventative and are not subject to deductibles/copays/coinsurance, so she has never paid for them.

This year she got it again. The provider is in-network with BCBS MA. However, BCBS MA applied the deductible and coinsurance to the cost of he ultrasound. My wife appealed it based on the fact that BCBS MA entering into a contract with a NY provider should subject the service to NY law. But BCBS MA disagrees, they say MA law applies, and MA law considers ultrasound to be diagnostic, not preventative. Therefore, the deductible and coinsurance are appropriately applied.

Two questions:

1) is BCBS MA correct in its assessment?

2) Can I appeal this to NY State?

Thank you!

submitted by /u/CentristPark
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