AFFORDABLE HEALTHCARE MAMMOGRAMS: know your code!

August 1, 2012

the new affordable health care regulations go into place this week.  i wanted to understand how they would affect my benefits – especially concerning mammograms since, as you might guess, i finally have no need for contraceptive nor gestational diabetes screening.  i found out that mammograms are covered and no longer limited to one per year but ‘as many as deemed necessary.’  but here’s the rub – and why you, the patient/consumer must be on your administrative guard:  it all depends on THE CODE!  so insist, talk and review with your doctor and with the administrative assistant who has your code-destiny at their fingertips. 

if it’s coded as PREVENTATIVE:  COVERED AND COVERED AND COVERED (not that anyone wants multiple mammograms in one year – smush…owe).  for my fellow survivors: i understand that you are entitled to COVERED-PREVENTATIVE MAMMOGRAMS if you have been 5 years post-diagnosis and with no recurrence/evidence of disease.  

if it’s coded as DIAGNOSTIC:  you are still on the hook for your CO-PAY.

Please check and recheck but here’s what I’ve been told:

SCREENING/PREVENTATIVE (COVERED) MAMMOGRAM CODES (2):  G0202 AND 77052

 DIAGNOSTIC BILATERAL MAMMOGRAM (NOT FULLY COVERED): G0204 AND 77051

we’re not talking pennies out of our pockets so KNOW BEFORE YOU GO. GET YOUR MAMMOGRAM AND BE HEALTHY – and save your co-pay for your next stress-reducing vacation!   

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wishing forward past the what if’s

January 5, 2011

popping in briefly to wish all a happy and healthy new decade ahead.  trying to get back into the routine of early (for me) risings with more purposeful doing and less puddling about.  i really feel that the last few months were this wonderful rolling party at our house …with friends and family coming together numerous times for tons and tons of food – all happily cooked in the renovated kitchen – no fights and no food disasters! success.

as always at this time of year, we have to make decisions regarding our health insurance.  each policy has gone up again (what else) and it’s a maddening labyrinth trying to work out the details about what if the worst happens …i don’t like revisiting what if but need to put my head together with my wonderful husband’s thoughts — and since he’s doing 90% of the work figuring it all out, i feel that i cannot indulge myself too much and need to step up to the responsibility plate.   i wish i were planning some fabulous trip.  maybe that’s the ‘what if’ i’ll focus on!


what if?

January 15, 2010

oh yeah.  what if?  what if we had a catastrophic year ahead?  what if teenage daughter broke her leg?  what if darling husband needed surgery?  we spent the last 3 weeks agonizingly dissecting the what ifs?  and one what if went unasked.  out loud.  what if i get sick again?  what if my cancer comes back?  what if what if what if.

the what ifs have been keeping me up at night.  we have been forced to ask because we are in the odd and dark world of trying to change our health insurance policy so that we don’t drown under the burden of purchasing it.  last year, we shelled out $2,000 a month for a ‘family’ policy (no one gives a shit that i only had one kid…i felt like someone should have been servicing my cat for that price).  we’re both independent contractors and all of my doctors were/are on oxford freedom plan.  none of them took oxford liberty – let alone other plans.  you could almost hear the secretaries hold their breath when the answer to what policy i held was: oxford.  before i could barely get the 2 syllables out of my mouth came the answer:  “we only take oxford freedom!  we don’t take oxford liberty!”  (you could hear the !!! ping at the end of each short but meaningful sentence.)  and 4 years post breast cancer diagnosis is not a good time to change your entire medical team.  so we have made concessions in order to remain with our oxford freedom policy.  but the financial burden became unbearable when, in december, i was told that the new monthly fee was $2,500 a month.  it was the absolute point of impossible.

and so we figured out some stuff.  we formed an llc – because we found out that having the company allows us to purchase a small business policy.  and then we went on the hunt.  insurance brokers; talk of hsa’s and hmo’s and out-of-network payments including deductibles and out-of-network payments excluding deductibles (i’m still a little fuzzy on these two but darling husband seems to have a handle on it.) 

my year has a set rhythm to it.  10 doctor visits are, essentially set.  and all are in-network.  3 major procedures (a bilateral mri, sonogram and mamogram) all of which are, for me, out-of-network.  but many of these plans cost a significant amount and then you keep paying in in-network deductible…many of them set at $2,000 more a year.  out-of-network deductibles climbing easily around $5,000-$7,000 more just for me.  my radiologist is out of network and she’s amazing.  caring, careful, loyal and very very good at what she does. 

my husband deserves a medal.  he waded through manila envelopes filed away in our basement trying to assess our past costs.  it had to be a nasty trip down a nasty memory lane to look at receipts for steroid prescriptions that made his wife stomp around feeling like her skin was coming off or the 4 different anti-nausea meds receipt gathered in everyone’s desperate attempts to get me some medication that worked to stop the nonstop hurling after the chemotherapy sessions.  and he kept going.  he added up numbers and crunched everything upwards and downwards and kept calling people who i would have hung up on but instead coaxed out answers that weren’t always immediately clear. 

in the end, we’re finally ready to make a pick.  a bit of an old-fashioned chinese menu:  one from column a and 2 from column b.  mine as a single with the best benefits and the lowest out-of-pocket payments and them together on a parent and child policy where we’ll be ok as long as neither of them go too far out of network.  or need major surgery.  i can’t help but feel that my worst fears are coming about:  as a family we’re not all together.  i’m once again by myself and husband and teenage daughter are tethered to each other.  i know that’s not really the case – but it feeds into all my old feelings of sitting by myself while the world just kept revolving and going on without me. 

what if?  what if?  what if?  and, for that matter, what if we couldn’t afford any of this?  so many can’t.  i mean it’s starting to really tax the system here (and by that i mean we’re struggling to pay it all out) but what if we couldn’t at all?  and the cat still has no health care.  what if? 

 


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