Insurance won't pay for MRI?

AutismMamma

Anyone have trouble with insurance paying for MRI?

My story: 35 years old a couple weeks ago I was getting out of the shower and found this strange area on my left breast. It is a long intended area and has a lump about the same size just next to it. The lump is not visible. I have very large heavy breasts. This area is 16 cm from my nipple, and 6 cm long.

My doctor was on vacation and so I saw another doctor in his practice who scheduled me for a mammogram and ultrasound. While there, the tech said they couldn't get a good picture on the mammogram because that indented area wouldn't flatten. The other skin folded up around it. She said it was "deeply anchored" whatever that means. They did a 3 D mammogram as well to get a clearer picture.

After that they did the ultrasound (which is where I found out the size and distance from nipple) and the tech couldn't find anything abnormal. The radiologist came in and took a look. She tried to manipulate my breast and also try to get a better ultrasound. Nothing abnormal except this visible indent, and palpable lump. She said its concerning to her because the lump is lumpy, not smooth. It seems to have bumps when you feel it. She said its also concerning that it stays creased when pressure is applied as in the mammogram, but seems to go away when my breasts are suspended, like when I'm wearing a supportive bra. She said she was recommending an MRI because some things that can't be seen in mammogram or ultrasound can always be seen through an MRI.

It's been a week and I just got a phone call that my insurance company won't pay for an MRI because of the way the report is written. This is what it says

"LEFT BREAST: No mammographic or sonographic abnormality found at the site of palpable lump and retraction. Given patient's symtoms, a breast MRI is recommended at this time. Negative, no mammographic or sonographic evidence of malignancy. Age appropriate mammogram follow up is recommended. Current mammography screening guidelines recommend a yearly exam for women over age 40.

Negative, no evidence of malignancy. Age appropriate follow up is recommended. Current mammography screening guidelines recommend ayearly exam for women over age 40.

OVERALL ASSESSMENT - CATEGORY 1 - NEGATIVE

END OF IMPRESSION"

The insurance company won't pay because it says negative results and follow up as age appropriate. So basically, have another mammogram in 5 years. So my doctors office said they will appeal the decision on my behalf because the MRI was recommended as well and because it's the only other diagnostic test to figure out what this is. She said if they won't do it, then they will send me to the breast center for a biopsy of the lump even without knowing what it is. I'd like to avoid that if at all possible, but I am wondering if anyone else ever had this situation? What are my chances of getting that MRI?