2 Oct, 2018 → by ClaimboUser309421
Refusal to fix wrong code

1

I went in for my annual mammogram in early July 2017. That same day I was called and told I had to go back for a diagnostic mammogram less than a week later. I worried for the week and went in and had it done. Early September 2017 I received a bill for $463 stating that I owed UPMC for that 2nd mammogram because Highmark had denied my claim. I called Highmark who informed me that UPMC had coded it as simply a regular mammogram and that they would only pay for one yearly mammogram and that all UPMC needed to do was change the code to Diagnostic. Thinking this would be an easy fix, I called UPMC who would not listen to me at all and told me very rudely that they never messed up and that if I had a problem with it being denied that I need to call Highmark. The rep even went so far as to insinuate that I myself had wanted that second mammogram a week after my first one - not the dr! This went on for three months - no joke. I finally got ahold of a rep at Highmark who called UPMC and spoke with a woman there and told her what to mark for the code. Now this was December of 2017. I heard nothing from December 2017 until October 1, 2018 when in my mail was a new bill from UPMC stating that I still owe them for the mammogram. And to top it all off, I received a second letter from UPMC that same day stating I was 2 months late for my yearly mammogram! Like I am ever going back to UPMC for any procedure ever again let alone another mammogram!!! I called the UPMC number on the bill and was told by the rep that the reason I hadn't heard anything from them in the ten months is they had been waiting for their "doctor" to look over how my procedure had been coded but he had never done it so they sent me another bill. I was livid so the rep said she'd personally call the dr this morning and ask him to look at my case. Amazingly what he couldn't do in ten months, he was able to do in less than 5 minutes and told her that everything was coded correctly. The rep called me and said that I need to pay the bill (even though I still have UPMC's letter they sent stating I needed a "Diagnostic Mammogram" to be done the following week) and that all I could do was file a complaint with Highmark because they had denied it. Back to UPMC blaming Highmark for everything. It's no wonder Highmark is washing their hands of UPMC! Am I wrong in wondering why a "doctor" and not an office manager is checking the accuracy of questionable billing codes? I don't feel I can trust anything that UPMC tells me.
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