I am an RN at a hospital, part of my employee benfit through insurance is a yearly mammogram screening. I called, scheduled my appt., which was already six months overdue; the receptionist asked me, "Did your Dr. refer you?" I said "No", I just need my yearly mammo." She looked up my last mammogram, said it has been over a year, so, it would be covered by insurance. She then asked, "Are you having any symptoms? Nipple discharge, lumps, pain, etc?" I said, "No, I just need my yearly screenig." She then ask who is my Dr., I told her my Dr. She once again asked me if I was having any symptoms or concerns . I was getting a little irritated at this point, how long does it take to make an appointment, I was at work, and needed to get going. I then thought a second and said, "Well, every once in awhile I have burning due to scar tissue from where I had a biopsy years ago, I've had it for long time, nothing I am worried about." Apparently, at that point they changed my status from screeing to diagnostic, without telling me. Now I am being billed for a diagnostic mammo, vs. routine. I did not know this until the bill came for $386. I did not authorize a change. My doc said she did not authorize a diagnositc change, she said I had not called the clinic or discussed with her any **** issues, and she would not have ordered a diagnositc, but the hospital says she electronically signed, which apparently she did, without even knowing? My insurance will not pay, they only pay for routine, not diagnostic. How can I be billed for a procedure that I did not authorize, did not even know was being done? I have taken this to the service excellence committee, the hospital is standing firm, I am trying to get them to change policy, it may not help me, but I don't want this to happen to anybody else, it does not seem ethical to me. Thanks in advance, any info or advice will be greatly appreciated.
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