Q: I recently received a notice from my Medicare supplement insurer that the claim for my annual mammogram was denied. I thought Medicare covered this. Is there anything I can do? I was billed $483. I became eligible for Medicare last fall and this was one of my first appointments.
A: Medicare covers one mammogram screening every 12 months. It’s important to keep track of these screening dates to avoid getting your mammograms too close together, but since this was one of your first appointments that shouldn’t be your problem. Medicare also covers diagnostic mammograms when medically necessary.
You pay nothing for a screening mammogram if the doctor or health care provider accepts “assignment,” or Medicare’s payment in full. For a diagnostic mammogram your supplemental insurer will pay 20% of the Medicare-approved amount and the Part B deductible (if any under your plan) applies. To learn how much specific tests or services will cost, talk to your insurer and your doctor.
The chance that this is a simple billing error is quite high. Since you so recently became eligible for Medicare, quite possibly the mammogram provider did not properly record your red, white and blue Medicare card for billing purposes. Since your Medicare supplement notified you of the denial, they at least received the bill. Look through the denial notice to see if you see the note “we need a copy of the Medicare Summary Notice,” which may be on the back of the notice.
If this is the case, immediately call your mammogram provider. Have a copy of the claim denial and bill at hand, and tell your provider that you have Medicare, but your mammogram claim was denied. First ask if the provider has your Medicare number and whether Medicare was correctly billed for this service. If not, then ask your provider to resubmit the claim to Medicare. Make sure that you confirm your Medicare number.
Customer service representatives of one the nation’s biggest Medicare supplemental insurers say that this problem happens pretty often, so stay calm — your supplemental insurer should still cover its share of the cost once Medicare pays first. Prompt action to call your provider should be all you need to do.
To learn more about the screenings and preventive services that Medicare covers, check the 2017 Medicare & You handbook. You can download copies at www.Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to order a paper copy.