Complaints

• Initial Complaint

  04/24/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  At my annual women's wellness visit on November 1, 2021, a UM BWMG provider ordered and recommended I get a mammography screening, despite the fact that I am only 32. The stated basis for the recommendation was that I am at "an increased risk of breast cancer due to family history," because my maternal aunt and maternal grandmother both had it. The provider failed to comply with the Women's Preventive Services Guidelines when she ordered and recommended the mammography screening. The Guidelines provide that "average-risk" women should initiate mammography screening no earlier than age 40 (https://www.hrsa.gov/womens-guidelines-2019). According to the NIH Breast Cancer Risk Assessment Tool (https://bcrisktool.cancer.gov/), I am at "average-risk" of developing breast cancer. Although the Assessment Tool considers a FIRST DEGREE relative who had breast cancer to be a risk factor, it does not consider a SECOND DEGREE relative who had breast cancer to be a risk factor. Had the provider correctly assessed my risk level or informed me of the Guidelines or the Assessment Tool, I would have realized that I am not at an "increased risk" for breast cancer and I would not have gotten the mammography screening. Since the mammography screening was medically inappropriate and unnecessary, per established clinical guidelines, BCBS denied the claim (even after several re-submissions). Since December of 2021, I have asked UM BWMG numerous times how to have the bill for the mammography screening (administered by Advanced Radiology) covered under its errors and omissions policy or otherwise paid for by the practice. I have not received any response to that inquiry. I received a final statement from Advanced Radiology (dated April 19, 2022) stating the bill may go into collections if not paid in 30 days.

  Business response

  06/12/2022

  Business Response /* (1000, 6, 2022/05/17) */ **BBB note: A response to this complaint was submitted by the business as a separate document that is accessible online. If you received this notice via email, please click on the "Write a Response" button to visit the unique online caselink, then, open the appropriate attachment. If you received this notice via postal mail, please type in the caselink into your web browser and open the appropriate attachment. If you have any questions, please contact your caseworker. Consumer Response /* (3000, 8, 2022/05/17) */ (The consumer indicated he/she DID NOT accept the response from the business.) I am not aware of anyone in my family undergoing genetic testing for the BRCA gene. I discussed the fact that my maternal grandmother and maternal aunt had breast cancer with the provider during my appointment. The practice's claim that I stated these relatives underwent testing indicating the presence of BRCA genes is absolutely false. No such testing occured and I would not have lied about that. This false claim appears to have been made in an attempt to bring the provider's reccomendation that I undergo a mammography screening due to "an increased risk of breast cancer" within the established standard of care.

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