Frequently Asked Billing Questions
Most insurances cover these services. Please call our billing department or your insurance company to verify the benefits of your health plan.
Simply, you will be covered if your insurance company follows the NYS breast screening law and your insurance company states the services are medically necessary.
However, the NYS breast screening law does not apply to insurances outside of NYS, although any state can choose to follow the NYS breast screening law. Currently, only five states (MA, MI, CO, PA and CA) DO NOT follow this law. The back of your insurance card will list the state where your insurance company is located. Medicare, Medicaid and NYS self-funded plans are not required to participate.
The NYS breast screening law eliminates any cost-share (copays and deductibles) by the patient for diagnostic breast imaging procedures such as diagnostic mammogram, breast ultrasound and breast MRI when your insurance policy is through a participating NYS plan and services are deemed as medically necessary.
Please verify your coverage with either the EWBC billing department or your insurance company.
A screening mammogram by definition is two sets of images of each breast (craniocaudal and mediolateral oblique). Occasionally additional views are ordered by the radiologist to determine a diagnosis. These additional images are considered diagnostic and applied to your deductible and/or co-insurance plan.
The term “covered” means that your insurance recognizes the procedure but does not necessarily mean they will pay for the service. You are responsible for your deductible and/or your co-insurance.
Coverage varies from one insurance plan to another, along with the services performed, and your individual risk factors or medical situation.
Yes, we can post to your patient portal, mail or email based on your preference. Please call our Billing Department at (585) 442-1830.