Does Medicare pay for your screening MRIs?

AnacortesGirl

My mom was dx'ed with stage I back in 2009 (two months before me).  Thirty years earlier she was dx'ed at stage 0.  After her surgery and radiation was completed, both of us went through genetic testing and found that we have a BRCA 2 mutation.  Since my mom only had lumpectomies, she still has both breasts.  Her onc has her doing alternating mammos and MRIs every 6 months.  So she has had a couple of MRIs already and Medicare paid for them.  The last one she had was rejected by Medicare.  She read me the paperwork that was submitted to Medicare and it included her dx and BRCA 2 status.  

Yesterday I submitted a question through the Medicare website and today I got the answer back: 

 Medicare will pay for lab tests and other diagnostic tests like x-rays, MRIs, PET scans, and stress tests, as well as the reading or interpretation of the lab or diagnostic test, as long as these tests and services were ordered by your doctor and they are medically necessary.

I believe the MRI is medically necessary.  But I'm already fighting with Aetna about my own PT claims that were rejected.  "Medically necessary" appears to be a vague phrase that is interpreted differently by the insurers than the patients.

Is medicare paying for other ladies who are getting MRIs for screening?

AnacortesGirl

Thanks for the info Sherri.  The imaging clinic is supposed to recheck with Medicare but I'm betting that doesn't change anything.  I suspect it's going to be a ferry ride over to mom's place and visit with her onc's clinic so we can get a letter from her onc saying it is a medical necessity and go through the appeals process.  Bummer.  I sure wish she wasn't across Puget Sound.

I'm down to the external review appeal with Aetna on my PT.  I'm still trying to settle down before writing the last appeal letter.  I don't want to say the things I really feel -- just stick to the facts.  I went through $350,000 with Regence for most of my treatment and never had any problems.  Now I'm down to the cheaper stuff with Aetna and they are trying to nickel and dime me.  It's just irritating!