If you have received a denial of coverage letter from Anthem, don’t worry
We are hearing from many members that Anthem is denying claims for mammograms because they do not cover digital, 3-D mammography, which they still consider “experimental.” You do not have to pay for this and here’s why.
Mammography technology has advanced to be able to provide a 3-D scan, and many providers now only have 3-D equipment. The older 2-D scan equipment is becoming obsolete.
Since Anthem considers 3-D mammography experimental, they are sending out notices, after the fact, telling patients the test wasn’t covered. However, so long as the employee and their dependents are using a participating provider, the provider cannot bill the member for services which are denied as experimental. The provider is liable, not the member, since they are contracting with Anthem.
The only exception to this is if you signed a waiver stating that you were aware of the cost difference and were willing to pay the difference.
The Health Benefits Committee, on which SEA/SEIU Local 1984 has several representatives, has been and will continue to work with Anthem to get 3-D mammography covered.
If you have more questions about this issue or any health benefit-related issue, you can Chris Porter at firstname.lastname@example.org. Chris is our Compensation and Benefit Research Specialist who will advocate for members experiencing challenges with their contracted medical benefits. We’ll post answers to commonly posed questions in this column.