MRI and insurance

CLC

When I was initially diagnosed with adh, mri alternating with mammogram was the expected and paid for course to take.  As I understood it, that was not to watch my one breast where the adh was excised, but to watch both breasts because it was now understood that I was at increased risk for breast cancer in either breast.  When my MRI was the test that led to my dcis diagnosis a year later, and I had a umx, I was told that MRI's were no longer the accepted or paid for course to take, even though I still have one breast.

My MO, at my perplexed and disbelieving looks and questions, said he would write the scrip and we would try, but not to expect anything.  That attempt comes in October.

I have been letting that just sit until then.  However, I read someone's post that said that for five years following dcis, they have been getting mri and mammo alternating and it made me realize that maybe I should be pursuing this harder.

First, am I correct in thinking that it only makes sense to continue MRIs since my risk certainly didn't go down upon my dcis dx?

Second, has anyone faced this battle?  For anyone with a dcis dx and one or two remaining breasts, do you get MRIs?

Any thoughts would be greatly appreciated.  Thanks! 

Claire

BLinthedesert

Hi Claire,  I had a MRI before my lumpectomy to help define the area that would be needed to be taken out during surgery (I had both a mass and some microcalcs nearby but not adjacent to the mass).  At that time they found a distortion in the opposite breast, but not serious enough for a biopsy - so they requested a 6 month follow-up on this breast.  Because of this I will be getting a follow-up MRI.  However, if this MRI is "clear" (which I am assuming it will be), I won't be getting any other MRI follow-up.  

Even though I have dense breasts, I feel comfortable with 6 month follow-ups with my BS and RO and yearly diagnostic mammograms/ultrasounds.  The use of alternating MRI/mammograms has not been adopted, yet, as standard of care - even for those with history of breast cancer - so, unfortunately, insurance companies don't have to approve their automatic use.  My BS has to get prior approval - so I would bet he knows how to make a case for use, if he believes it is a requirement.  

Good luck ... I hope your medical team advocates on your behalf, it is so important that you feel comfortable with your follow-up. 

proudtospin

ok, so I have basic insurance that will not support MRIs so my BS who orders my mamos always says "ultrasound if needed"

4 years out, nothing on the right has ever come up but this last mamo had new things found on mamo, ultrasound and a biopsy should only B9 stuff.  (Onco told me this week it was fat necrosis which is dead cells appearing from my rads and common after 3-4 years)

I am sure that the reason the MRI has never been ordered on me is due to the insurance that I have...times I worry but then I think it is what it is

1openheart

I had a grade 3, extensive DCIS diagnosis last April.  I had a UMX with direct to implant reconstruction.  I had a MRI at the one year anniversary of my diagnosis.  I had a dx. mammogram at 6 months post surgery on the remaining breast.  I have another dx. mammo. scheduled at 18 mos. out, this time on both the natural and the reconstructed breast.  My MO says her plan is to alternate MRIs and mammograms for at least 5 years.  My insurance paid for the first MRI without prodding on my part.  We'll see how the next one goes.

CLC

Thanks, all, for your feedback.  I guess I will have to get a bit pushy with my insurance company and doctors...:)

J9W

I have both MRI and mammo, usually on an alternating 6 month period.  My insurance has never given me a problem about either.  Blue Cross is my insurance company and that may make a difference too. Plus, my family is filled with BC.

CLC

J9W...Blue Cross is my insurance, too...hmmmmm.   Thank you for that info...  I am feeling a little more ready to pursue this.  I think this might just be a case of the doctors having dismissed it out of hand...and I may make some headway...

juliet62

dcis april 2011,new califications in nov 2011 mammogram, mri paid for by insurance without problem,

CLC

Thanks, juliet62!!  I am feeling pretty ready to pursue this harder!  Thank goodness for bco and all of you fantastic women!!

Infobabe

CLC 

No MRI has been requested on my behalf but my primary physician told me a few days ago that they are having a very difficult time getting any MRI approved anymore.  It seems to be the trend with insurance companies.

CLC

thanks, Infobabe...we shall see...

tweetybird

CLC,

I reached my 5 year mark last July. I was alternating between MRI & and Ultrasound and Mamo/Ultrasound every 6 months for the first 5 years. They were approved by my insurance company, with no questions asked. But when I went to schedule the one for last August it was denied twice, by my insurance company. The first time was due to "No family history" of breast cancer, I guess having having caner doesn't count, and the second time was because after the 5 year mark they said it's not the "normal protocal" for breast cancer patients.

When I went to my surgeon, who was the referring Doctor, she said that is becoming the norm now for insurance companies to deny MRI's because they are too expensive. I guess thhey don't want to shell out $5,000 for an MRI, but would rather shell out hundreds of thousands of dollars for a recurrance, and we all know the expense of surgery, rads, chemo, and reconstrution is.

I also live in New York, on Long Island, and have the same insurance/plan that you do. You might want to fight like crazy and see if your Doctor can back you up.

Good Luck!!!!

CLC

Thanks, Janet...yeah...they don't want to shell out the money.  But it is odd, because the doctors had to convince me to have the mri when I had adh (I was resistant because of the injection) and there was NO insurance questions raised.  You would think dcis would have increased the basis for it, not reduced it...sigh.