Insurance and MRI

akc820608

2 days after my surgery last week, my symtoms came back.  My BS called and said the pathology was benign, but wasn't sure why my sypmtoms only went away for a couple days.  They told me to see general practiotioner in the town I live, rather that coming back to their office which is 3 hours away.  My GP recommended a breast MRI, but said it is tricky getting insurance to pay.  I go back to my BS Wednesday and my GP told me to ask if they could order one so insurance would be more likely to pay.  Anyone have any similar situations?  How did you get insurance to pay?

akc820608

Gees. I meant symptoms.... Both times.

SecretAgentL

Hi, akc820608-

I'm so sorry you're going through this. It's scary and frustrating! I'm a high-risk gal due to some atypical findings in my left breast back in 2006, so as a result, my insurance company paid for my breast MRI (and I'm only 34). I live in Pittsburgh, which is an incredible city for medical resources and facilities, so I'm very, very blessed to be a part of the Hillman Cancer Center's High Risk Breast Program. 

I think it's a good idea to have your BS request an MRI, as the insurance company will be more likely to heed the request of a specialist. Also, if you've had any other breast issues prior to this one, have your BS mention that as well. Might make it more of a compelling request. 

I'll be thinking of you. Anything I can do for you in the meantime?

hug,

Laura

akc820608

Thank you, SecretAgent!

This all started in Oct. 2011.  (actually earlier.  my first symptom started summer of 2011, which was nipple discharge.)  Did an US which showed complex cyst.  Aspirated, and went back about a month before my 6 month follow-up appointment.  Found what they thought was a fibroadenoma.  Pathology found, indtraductal papillomatosis with mild atypia.  Dr.'s office called Tuesday and said benign, but dr would go over specifics at my appointment on the 11th.  So, I think it would put my mind a little more at ease if the MRI was performed.  If it weren't for the symptoms coming back and getting worse, I probably wouldn't think about it as much. 

Oh, and I feel for you.  I am 29.  Hope your procedure goes well!  Keep us updated!

 Virtual hugs to you!

 Angie

SecretAgentL

Angie,

I had an atypical papilloma, too! Well, at least that sounds like what you have or very similar at least. And, yes, while it IS "benign," it still increases your lifetime risk for breast cancer by about 4-5 times. So, because of that, I think you should ABSOLUTELY push for an MRI. PUSH, PUSH, PUSH. This is YOUR body, your ONE life. You need to fight for it. If your BS won't agree to it, get a second opinion. I've been VERY blessed that I've had medical professionals advocate strongly on my behalf, but I understand that not everyone has that. That's why you need to fight. And while you're young, a diagnosis like yours (and mine) is very rare for our age. So all the more reason to get proactive and start having people take you and your body seriously and watch you closely.

Definitely private message me if you want, okay? I'll be thinking of you on the 11th! Let me know what your doctor says!

big hugs,

Laura

Delilahbear

akc820608 - I had nipple discharge in left breast and had duct with papilloma removed. Path showed not only papilloma but other atypica as well. Earlier (3 years prior) had fibroadenoma and sclerosis papilloma as well as multi focal atypical metaplastic changes, removed from left as well. One year to day later had discharge from right nipple. This time they did ultrasound at one hospital that was so full of papillomas they could not rule out anything. My BS (who has been my PCP for 14 years) sent me to another hospital breast center for bi-lat US. This showed the same in both breasts. Next was the MRI which came back bi-rads class 4 suspicious. Had 4 US guided wires placed for surgery and path came back papillomatosis ADH and other atypia.

Long story short my insurance had no issues paying for MRI due to previous history. In the end pathologists suggested DX of very diffuse papillomatosis and BS said we would continue to fight this battle with biopsies and ductal removal. At the time I was 57 and with some family history told her to do what it would take to get insurance to pay for BMX which I had 3 years ago and haven't looked back.

I realize you are both young and it would be radical at this time but wanted to share my experiences. .

Secret Agent - I am originally from Washington, PA and know about the fabulous resources Pittsburgh has. You can see from my Avitar that I am a WVU grad.

clevelandgirl99

Insurance can be such a pain.  Although I thought I had approval prior to my MRI, it came back denied.  It was finally straightened out and approved.  Unfortunately I needed an MRI guided biopsy which has yet to be approved.  It was performed in Sept 0f 2011.  I was on the phone with both the insurance company and the doctor's office again today trying to get it resolved.  The insurance company said they need more information; the doctor's office says they have faxed it.  Meanwhile I have a $6,500 bill from the hospital.

It makes no sense that the MRI was approved but not the guided biopsy that was needed as a result of the MRI.  Try to get approvals ahead of time.  And even if insurance covers it, they may not cover all of it.  So far this year I've spent well over $2,000 out of pocket and that doesn't include last year's mri which I paid for this year as well.  Crazy how expensive this all can be! 

Good luck to you!

Shar1

I am just beginning my journey with the breast cancer scare----so I can only begin to see how you must feel.  My mammogram came back abnormal and I was called back in for a lateral spot compression and was then immediately sent for an ultrasound.  Apparently I have a very dense spot near my chest wall and ribs and they are unable to get a clear view because of the location.  Since this spot is not normal and my mammogram has changed in the past year they are sending me for a test called BSGI- Breast Specific Gamma Imaging.   I was told that this test is able to detect the presence of cancer immediately and is comparable to an MRI and is much cheaper.  I just got my doctors order today and should go for the test next week.  I wish you the best of luck in your fight with cancer and the insurance company!

akc820608

Thank you, everyone, for your replies!  Much appreciated.  I go back to St. Louis in the morn!

GODISGOOD2012

The B.S.G.I. machine found my cancer!!! I had no problems with insurance paying for this test. I highly recommend this for all women who have DENSE breast tissue!!!

oregongal

I have had 16 years of breast issues (papillomas, ADH, lumps) and only this year was able to get an MRI.  My insurance company wants a family history or cancer diagnosis.  I've lost most my family to cancer. no one reaching age 68 and losing the battle within weeks of their diagnosis, but no breast or ovarian cancer. My BS sent a ton of documentation to the insurance company, they probably got bored reading through it and finally okayed it.  I will tell you, the MRI gave me such peace, it showed the 6 papillomas they saw on my ultrasound, but no other issues currently.   All my issues were on the right side and I always wondered about my poor left side. But there were no issues on the left and the implants I have from reconstructive surgery looked good.  I get checked again in October and now am hoping it will be back to the ultrasound.  Way cheaper for me, the MRI costs me $950, I had met my deductible, but my insurance is not that good.

bdavis

I had a denied MRI last month, and have a cancer diagnosis.... they said that I should have had a mammo first, but those have not worked for me... so I appealed it and won. The bilat MRI was $2800 but now I only owe $40... THANK GOD... I would get a precertification. I know that when my breast surgeon ordered the first MRI I needed to have it precertified.... guaranteeing payment. Then a week later when I had a MRI guided biopsy, I didn't need pre-cert... This most recent MRI was after BMX and recon and I wanted to assure myself that all was still good.