My mammogram billed as an outpatient surgery!! Advice please...

  1. I had a ductogram/mammogram and recently received the bill from the hospital. According to our insurance they pay 100% w/no deductible on x-ray procedures. The mammogram I had just two weeks prior to the ductogram was covered 100%.

    When I showed up at the radiology department, with my radiology doctors order, I signed in, nobody asked for my deductible up front as they do in same day, the day before when you go for pre-op labs, CXR, and EKG. The radiologist inserted a very tiny needle about 1/8" into my left nipple and injected some dye. Then they did a regular mammogram. Now I'm being told that this was considerated a same day surgery procedure and I owe the $250 deductible.
    I was told....get this.....the doctor used sterile gloves! Well yeah! I use sterile gloves in my job all day long and I'm not a surgeon.

    I don't want to pay the $250 deductible. What would you do?
  2. 3 Comments

  3. by   TiffyRN
    Don't you love insurance? It sounds like you had an interventional radiology procedure. This bit me the other way a couple of years ago. My outpatient surgery deductible would have been $50, x-rays were applied to my $500 deductible. I wound up having to pay almost the entire bill for an IVP and voiding cystogram, because they were considered x-rays (they used an IV and sterile gloves).

    I would appeal to the insurance company to start. I've called my insurance before and they actually found in my favor. I called them because I had a $900 pathology charges. When I called they found they had charged me the out-of-network price (inappropriately) and the charges were reprocessed and came to less than $50.

    If talking to the insurance company doesn't work, maybe appealing to the hospital/center where you had this done. Maybe they can reconsider this as a surgical procedure, I can't imagine any hospital being able to justify this as a surgical procedure gloves or not. You need to ask for their specific criterion for what is a "surgical procedure". It sure better entail more than a pair of sterile gloves. Geesh, I've had endoscopies and as far as I know they don't require sterile gloves but they are treated as "outpatient surgery".
  4. by   DutchgirlRN
    Thanks Tiff, I will appeal to the insurance company. I hadn't thought of that (duh) I guess I was just too upset. I did appeal to the hospital where it was done and where I work and told them this is NOT outpatient surgery and should not have been billed as such. Thanks again.
  5. by   Aneroo
    I hope you're ok! I've never had a mammogram, so I don't know what's routine, but I'm sure the dye part isn't. Hope you're doing well physically and mentally. -A