B-MRI: is anyone getting them for regular screenings?

peggy_j

Is anyone able to get their insurance to pay for B-MRIs as a regular screening test? My cancer docs all recommended this from the get-go, but my insurance will never approve it.

The first year my MO and I went through the long appeal process, including an "external appeal" (outside the insurance company) and still the insurance rejected it. This past year, my mom was Dx'd with ovarian cancer. Since this increases my risk for BC even more, we tried again. Again, I got rejected. I think it must just be my insurance company. (Initially they weren't going to pay for my BRCA testing, but they eventually gave in, upon appeal). I have a friend who lives in another state and she got a B-MRI approved and she doesn't have any history of BC herself or in her family, but it was approved because she has dense breasts. I do too but...my insurance company said they were dense but not dense enough. arg!

Any thoughts/tips on how I could get this approved? If it wasn't so $$$ I might pay myself, but it's like $5000!

farmerlucy

I get one every year. My onc does it for all her patients. Not sure how she gets them approved but she does. I asked a couple years ago what the cash price would be ifinsurance didn't approve and it was like $1k. She said she might consider every two years after five years.

peggy_j

Thanks farmerlucy. I wonder why the insurance companies are so different. FWIW, the B-MRI I had after my BC Dx (and prior to surgery) was $5K (two images, one with contrast). The insurance covered it, but I saw the billed price on the statement of benefits. Shocking that there can be such a big difference. And...I checked w/ my friend who gets them approved even w/o a BC history. Her mammograms also shows she has numerous cysts, so I wonder if that's a factor. Anyway if anyone has tips, let me know. My MO and her staff seem to be doing everything that can. I wonder if it's just my cheap insurance company.

momand2kids

Hi

I was getting an MRI every year per my oncologist... I stopped in 2013- requested to go every 2 years (will go in November).... I just figured after 5 years it made more sense to do it less frequently--less stress. But I never had a problem when it was annual to have it paid for by insurance----

dtad

Hi Peggy. May I ask if you have dense breasts? Insurance should definitely cover it if you do. I had a pre op MRI which found a second malignancy that did NOT show up on my mamma or ultrasound. When you have dense breasts MRI is really the best tool. Good luck to you....

Hopeful82014

My BS wants me to have them starting in January (alternating w/mammograms) and I am anticipating a battle with my insurer as well, since they've fought me at every turn. I do have somewhat dense breasts and a mutation but my (former) MO who is head of the high risk clinic run by my insurer is saying "maybe" MRIs, which doesn't sound good to me.

You might try taking it to your State insurance commission if necessary. Good luck with it; it's bad enough to have cancer and having to fight your insurer is adding insult to injury.

LRM216

I have BC/BS and for the first 3 years after initial treatments, I had a breast MRI every year, along with my 6 month mammos. I was early stage Triple negative - had 4 rounds of A/C and 4 rounds of taxotere - 6 weeks of radiation and two lumpectomies (second one for one dirty margin). At year 4 insurance company refused the breast MRI - my breast surgeon appealed it three times - to no avail. The reasons the two doctor panel rejected it was:

1. I was 62 when diagnosed (???????);

2. I was the only one in the family with breast cancer; and

3. I had no genetic testing (which they refused to do in 2009 since I was 62 at time of diagnose)

One has to wonder at the reasons I was given as to the denial. Are these doctors making these decisions brain-dead or just plain stupid? I hate insurance companies.

peggy_j

Quick update: my B-MRI was finally approved! Yay! After getting rejected, my MO's nurse handed it off to my BS's nurse who resubmitted it with my complete health history, and it got approved. (I have no idea what she included that the other nurse did not. When we spoke she just said, "Now we know what to include." Maybe it helps if the BS subs it, instead of the MO??? Who knows?) I had the test this week and got the results--all good! Whew! FWIW, the rate was closer to $3500 than the $5000 that I remember when I was first Dx'd. (I'm too lazy to dig out my old insurance papers). Thanks everyone for the encouragement. I hate the hoops we have to jump through with the insurance companies. Keep the faith!

WinningSoFar

Congratulations, peggy, for winning this round. Doesn't that feel great to best the insurance company (or, more diplomatically-put, to convince them of the medical necessity of an MRI). Yeah!

AKJ

My onc recommended yearly MRIs because of family history and dense breasts. My insurance covers it. I have to wait for the approval before I make the appointment but it hasn't been a problem.

peggy_j

Yeah, I happily surprised that it got approved on only one level of appeal. Who knows what goes on in the minds of these insurance companies?

I have other non-BC stories that are insane (I once got a shot prior to traveling abroad. Initially the insurance would only cover the shot but not the doctor's office to get the advice and administer the shot. It took a few rounds to get that straightened out. And it was cheap, as far as medical costs go. madness).

NJ-Jen

I got mine approved this year but the insurance was sticky on where so I can't go to the hospital but only to a stand alone facility. Good thing as my mammo's all clear but MRI showed masses in both breasts.