Triple Negative - Annual Breast MRI without Mammogram

lindarella

Just curious if anyone with triple negative breast cancer has had success persuading doctors or insurance companies to approve annual breast MRIs without a mammogram?  My insurance (Anthem Blue Cross) has denied a followup breast MRI without a mammogram first, and my doctor wants the mammogram too and is reluctant to appeal.  It's a sad state of affairs when a doctor advocates for the insurance company instead of the patient.  I was diagnosed with TNBC a year ago and had ultrasound and breast MRI before lumpectomy and sentinal node biopsy - PET/CT scans and bone scan after surgery (no metastasis): female, age 51, IDC, 2.5cm, Stage IIa, Grade 3, 0/6 nodes, ER-/PR+, HER2-.  I completed one round of A/C chemotherapy and 4 doses of radiation before abandoning treatment.  I see my oncologist every three months for an examination and bloodwork.  I've learned alot about myself and modern medicine in the process, and my decisions to do what is best for me do not always agree with the doctor's recommendation.  It's my understanding annual breast MRI's are considered medically necessary in high risk cases as outlined in Anthem's policy, but there is no mention of those who already have a history of triple negative breast cancer which is also high risk: http://www.anthem.com/medicalpolicies/policies/mp_pw_a053263.htm  

Luah

I'm in Canada. I asked for (and received) annual MRIs in addition to mammograms for 2 years following treatment. I don't think I fit the high risk guidelines, though, and I didn't get one this year, which I'm okay with.  

crabbiepattie

Some women report they can get an annual mri approved if they have dense breasts. That's what my surgeon is doing for me, offset 6 months from the mammo. I don't have Anthem - hopefully someone will reply with Anthem experience.  Wishing you the best!

msjag

I don't have Athens insurance, but due to dense breasts.  I do get a 3-D mammo and a yearly MRI...just had my MRI  (been three years and all clear yeah!)  I do believe my insurance does require mammo first...I didn't wanted the radiation from it..but I did want the mammo...esp the 3 D.  I have appealed  a decsion with the help of my onc and surgeion, and MRI was approved and has been yearly.  Maybe worth nudging your doctor to appeal. Hope it works out for you.

jenjenl

The tech that does my mammo indicated she would recommend chest MRI's vs a mammo.  My OB ordered my MRI and there was a little back and forth with BCBS but it was approved, go next Thursday for it.  It's not approved as an annual activity though.

lindarella

Thanks very much to everyone who replied.  I have an update - my MRI appeal to Anthem was approved - it's a miracle.  In the appeal, I outlined what their policy states along with my diagnosis, as well as a letter from my doctor and medical records.  More research is showing that MRI is a better diagnostic tool for TNBC in particular, and we can only hope they find better treatment options too.   God bless you all in this journey!