Windsong Radiology

Revdex.com: I have reviewed the response made by the business in reference to complaint ID ***, and have attached my response as a pdf file aboveThe issue remains unresolved because we still do not know the outcome of our complaint. Regards, *** *** We
appreciate the Revdex.coms efforts to resolve the issue and hope that Windsong
and the Empire Plan will be able to resolve it in *** ***’s
favorGiven Windsong’s statement (as quoted below) that it was required
in *** ***’s case because of her dense breast issue and breast
pain then it is not clear as to why the insurance carrier has denied
coverage thus far. Ms ***a writes, “however upon presenting for her
exam, the patient complained of pain in the left breastBecause of this
medical complaint, our radiologist ordered a digital diagnostic
mammogram along with a breast ultrasound for further evaluation
Additionally the patient received educational material regarding the
Digital Breast Tomosynthesis (DBT) procedure prior to her exam and
requested the DBT to be done at the time of her visit and the
technologist recorded the request on her worksheet.” We wish to
reiterate that the patient, *** ***, did not initiate or seek
the DBT and the breast ultrasound when she reported to Windsong for the
mammogramBefore the exam, *** shared her previous mammogram and the
attendant report with the technician and mentioned that she had some
breast painThe technician indicated that Windsong did the advanced 3D
DBT and that it could be done in her case as wellIt appeared to ***
as a more sophisticated version of the standard mammographyThe issue
of it being a much more expensive test--- something that is not
routinely covered by insurance carriers---- was not disclosedIn view
of ***’s breast pain and dense tissue, if the radiologist at Windsong
felt that the DBT was necessary despite the cost, we don’t understand why The Empire Plan has denied it’s coverage for so many months.Sincerely, *** *** (husband of *** ***) *** ***

I'm responding to the complaint this patient filed with you regarding her mammogram studyThe patient's physician ordered a screening mammogram; however upon presenting for her exam, the patient complained of pain in the left breast Because of this medical complaint, our radiologist ordered a
digital diagnostic mammogram along with a breast ultrasound for further evaluationAdditionally the patient received educational material regarding the Digital Breast Tomosynthesis (DBT) procedure prior to her exam and requested the DBT to be done at the time of her visit and the technologist recorded the request on her worksheetThe tomosynthesis was done due to the patient's dense breast tissue and clearly met the standard criteria for the use of the DBTAccording to the American College of Radiology (ACR) Practice Guideline for the Performance of Screening and Diagnostic Mammography, the ultimate judgment regarding the propriety of any specific procedures or course of action must be made by the physician or medical physicist in light of all the circumstances presentedThe following information will help you understand the difference between a screening and diagnostic services and why it is the responsibility of the conscientious Radiologist to adopt a course of action which is indicated by the condition of the patient and advances in knowledge and technology, Screening Mammography- is an X-Ray of the breast of a patient with no symptoms, complaints or surgical breast historyTwo standard views of each breast are obtained, and there are no abnormalitiesdetectedThere is no requirement to have the Radiologist on siteThe Radiologist who interprets a screening mammogram is allowed to order and interpret additional films based on any abfindings of the screening mammogramWhen a Radiologist interpretation results in additional imaging for diagnosis, both screening and diagnostic mammography services are correctly billed if appropriateDiagnostic Mammography unlike Screening Mammography, the diagnostic exam is performed on patients with signs or symptoms, prior surgical history for breast disease, patients with a possible abnormality detected on screening mammogram or on patients who had prior imaging findings requiring specific shorter term follow upAdditional imaging views and/or techniques are utilized, and there is a requirement to have a Radiologist on site directing the imagingThe goal of diagnostic level mammography is to obtain information that leads to specific interpretive conclusions and/or further diagnostic and management recommendations or course of actionThe patient's history, symptoms, physical exam and results of other prior mammography will dictate the necessity of the diagnostic mammogramAccording to the ACR, symptomatic women or those with previously detected abnormality for whom a short-term follow up or further evaluation has been recommended, are NOT candidates for screening mammographyIn addition under the Mammography Quality Standards Act (MQSA)if a woman arriving for a screening examination indicates she has a clinical breast problem, the facility must have a process by which she is converted to a diagnostic level examThe patient's insurance carrier has denied the DBT charge and at this time, our billing staff has submitted written inquiries and provided additional information to the carrierIf the insurance continues to deny this procedure, a New York State complaint will be filed with the Department of HealthAt this time the patient has not received a bill for this portion of the study and it will be held until all appeals have been answeredWe remain confident that her carrier will allow coverage for the DBTOne in eight American women will develop breast cancer sometime in her lifetimeThe stage at which breast cancer is detected influences a woman's chance of survivalThis patient clearly met the standard criteria for the imaging performed and once the DBT appeal is satisfied, we will consider the matter closed.Sincerely, Nancy ***Patient Liaison

I received your follow-up to my response sent earlier regarding the mammogram charges from January 2016 on this patient. I again contacted the Manager of the office to obtain any possible additional insight for this patient visit.Please let it be further noted that upon arrival, the patient reviewed and signed our billing policy which includes the the following statement: 7. RADIOLOGIST DISCRETION: occasionally In their professional capacity, the Radiologist may require additional imaging or modify procedures to obtain the most definitive diagnosis. Your signature allows us to bill your insurance and/or you for associated fees. The Radiologist who read the exam reviewed it with the patient prior to additional imaging. The patient complied and the technologist performed the additional imaging needed. While its possible that patient was not directly provided a written card explaining the transition of screening to a diagnostic exam, it is clearly posted in all dressing rooms as a secondary means of communication. We find it concerning that this patient insists there was no communication from our team. The patient describes herself as a low risk patient. As previously reported, on the date of her exam the radiologist found a questionable area in the left breast. The additional imaging provided the necessary diagnostic information which ultimately allowed for the final diagnosis. As per the prior guidelines submitted, the patient clearly met the standard criteria for the imaging performed and charged. We have no additional information to provide and must now consider this matter closed. We aresorry she is unhappy with our level of service, and hope she will continue to receive annual mammography.  Thank you,  Nancy [redacted]Administrative Coordinator & Patient Liaison

I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.Regards, [redacted]I absolutely DO NOT accept this, despite it being...

your "protocol".  AND I was ABSOLUTELY NOT provided with ANY type of "written card" or an explanation of any sort as to what was happening or  why I was being given additional testing.  There was NO COMMUNICATION of any type on this day between me and the technicians.  For a medical facility to continue doing questionable testing on a LOW RISK patient , such as myself illustrates total disregard for the patient. Given my healthy history of mammograms, your "protocol" should be to discuss with the patient your concerns and offer them the opportunity to reschedule another appointment after checking with their personal insurance provider. OR call the insurance provider themselves to verify additional testing is covered.  It is certainly not the patient, (who is sitting in a little cubicle not know what it going on or why additional testing continues to be done) "TO KNOW" what their insurance does or does not cover considering I didn't even understand what was being done, is ludicrous.  I sincerely hope we can resolve this matter to my satisfaction so no further action is necessary on my behalf.