I’m feeling overwhelmed trying to figure this out. I’m 31 and had a diagnostic 3D mammogram and ultrasound after my doctor felt a lump in my breast. The imaging center sent me a bill for just over $1,200, which is much higher than I expected. I have a high-deductible health plan, and I know I have to meet my deductible first, but this feels excessive. The codes and costs are below:
Does anyone have advice on getting this reduced? Can I ask to pay out of pocket instead of going through insurance? Any insight would be appreciated, or if anyone has had similar experiences, feel free to share.
You can try asking if they’ll accept a lower amount, but don’t expect much. Many providers will offer payment plans to help spread out the cost, so it’s worth asking about that too.
Did you get this bill directly from the provider, or is it from your insurance company? If it’s from your insurance, check the Explanation of Benefits (EOB) to confirm the charges match. If not, contact the provider to fix any discrepancies.
If the EOB matches the bill, you can ask the provider for a cash-pay price, but keep in mind that some providers have contracts with insurers that may prevent them from switching to a cash rate once the claim is processed. Also, cash-pay discounts usually require payment in full upfront.
For the future, you might want to use stand-alone imaging centers, as they are generally less expensive.
I had a similar situation years ago. My screening mammogram was covered, but the diagnostic mammogram and ultrasound weren’t, and my out-of-pocket cost was over $2,000. It’s frustrating, but those prices don’t sound completely out of the ordinary, especially in high-cost areas.
If the imaging center is in-network, they can only charge the negotiated rate, even if you haven’t met your deductible. Check your EOB to confirm the charges. If you haven’t received it, reach out to your insurance.
I’m sorry you’re dealing with this. I went through something similar when I found a lump and needed diagnostic imaging. The costs you’re seeing are much higher than what I paid at a stand-alone imaging center. It might help to shop around in the future, but I know that’s not helpful right now. I hope everything turns out okay for you.
Those prices seem high. For comparison, I recently had a diagnostic mammogram and bilateral breast ultrasound, and the total cost without insurance was $450. It might be worth checking if the imaging center has a cost estimator on their website or asking about their cash rates.
Jordy said: @Ashton
Do you know if there are laws requiring imaging centers to post their prices? I couldn’t find any cost information on their site.
There’s a federal law requiring hospitals to publish prices, but I’m not sure if it applies to imaging centers. It’s worth asking the provider directly about their pricing policies.
Harlem said:
If you’re on an ACA plan, mammograms should be covered. Did you check whether your plan classifies this as preventive or diagnostic care?
Diagnostic mammograms aren’t the same as preventive screening mammograms. The diagnostic ones are subject to your deductible, which is why you’re being billed.