Your doctor ordered a second mammogram? Sorry, it’s not covered

Filed Under: Costs, Patients, Providers

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A friend writes:

I need to get a second mammogram and my $743.55 per month Blue Cross insurance will not pay for it.

I have a (single parent/child) Blue Cross/Blue Shield independent Horizon EPO Plus health insurance policy.  I’ve been told that I’ve already reached my maximum for the calendar year of $600 in testing. I live in New Jersey.  The second test is necessary because there was not total visibility on the first one, and the technician would like to try it from a different angle.

So how much does a mammogram cost? Glad you asked.

Trying to get a straight answer to what it will cost to pay for myself, I have been sent into multiple loop-de-loops at the facility where my first mammogram was conducted, which is also where my daughter was born 16 years ago. My employer-sponsored Oxford plan at that time required a mere $100 co-pay for my entire pregnancy and delivery, including two weeks of intensive neonatal care in the hospital for my baby.

I turned to clearhealthcosts.com to find a facility to do my second mammogram at a price I can afford to pay. I also want to share my story of how an educated professional who at this time last

year had a six-figure income and 100% company-paid insurance could wind up in this position.

Technically, I needed to get a doctor’s prescription for the second one, but they asked for another angle. So I don’t know that it was a “screwup” or if maybe they saw something they wanted to investigate further and are just staying mum until the second one.

I saw the movie “Sunlight Jr.” recently during the TriBeCa Film Festival. Depicting the story of people living on minimum wage and at the financial edge, it also showcases the impact a lack of health insurance has on day-to-day life choices.

In one scene, the lead character, played by Naomi Watts, goes to a hospital for a sonogram because she is bleeding and thinks she may have miscarried her unplanned baby. In fact, it is a false alarm and she gets to see the beating heart and movements of the fetus for the first time.

This blissful moment is shattered when her partner, a paraplegic alcoholic played by Matt Dillon, rages at her for going for medical care, screaming “You should have called me. I know how these hospitals work. How are we ever going to pay for this? “

After the film and a Q-and-A with the director, my girlfriend expressed surprise that she had not picked up that the point of the movie was to shine a light on the real lives of people who are living this way.

I told my friend I related to the story because I too am living a variation of that nightmare.