DCIS follow-up care protocol when insurance denies MRI's

picklesmom

I was diagnosed with DCIS 18 months ago. I had a lumpectomy and radiation. I am ER/PR negative, hi-grade, necrosis. 5.2 cm. I had an MRI at the time. Surgeon and oncologist said I would have alternating mammograms/MRI's every six months. I had a mammogram six months ago and was scheduled for an MRI this week but insurance has denied coverage for it. Knowing how closely I would be followed is one reason I chose lumpectomy over mastectomy. I am going to talk to my insurance company this week and wondered if this is something worth fighting for and tips on how to get approval for the MRI. Thank you.

rosierosie

I just had a MRI yesterday my surgeon order a mammo, ultrasound and mri, my dr put down the same code for a DCIS for the MRI I think the code do something ask your Dr office if they can put down a certain code so you are covered.  I had DCIS lumpectomy and radiation and tamoixfen Iow grade I how this help you just make the dr office check the code.

Legomaster225

I recently had a post neoadjuvent MRI denied by insurance initially. My BS called the insurance company and did a peer to peer review and got it covered. Definitely talk to your doctor and the insurance company if you need to. The doctors offices have to deal with this all the time. Be persistent.

picklesmom

This is helpful and encouraging. Thank you for sharing.

Annette47

If your doctor wants you to have MRI’s then definitely fight it with the insurance company.

That said, my follow-up did not involve MRI’s. I had 6 month mammos for the first 3 years, then went back to yearly. I get clinical exams 5 times a year (twice from my radiation oncologist, twice from my medical oncologist and once from my surgeon). I suspect after this year (when I hit the 5 year mark) that will decrease as well, but so far they haven’t mentioned how long they will all be following me.

MTwoman

I agree with Annette, if your doctor wants MRIs then they're worth fighting for.

I also had DCIS, but ended up with mx. 2 of my lumps were not found on any imaging other than mri, and mri was not suggested for my follow up either. Like Annette, I had mammos (on my good side and clinical breast exams on my mx side) every 6 months for the first 3 years, then every year. Now, I am "down" to screening mammos yearly. I'm 14 years NED, so hope that is encouraging.

Mariangel43

Picklesmom, tell your doc to justify the need for the MRI. Only the code of diagnosis is not enough. Plans want to have money gains. The problem with MRIs is that only one is authorized yearly under normal circumstances. But the doc should emphasize the need of follow up to help case managers reviewing the medical orders. I recently had a fight with one plan representative over a CT. I told them I would demand them if I got a cancer spread to my lungs and they were denying it or postponing the authorization; (next time besides the suing I will send a letter to the newspaper and to Facebook where they post their ads and will write down a complaint with Insurance Commissioner). They hate bad advertising. You have to fight with the plan sometimes. Other times let your doc do the fighting.

My next battle with my plan is on September. I will send my order for a US and sit for three weeks until they approve or not the order. I hope they do. Good luck, lady.

piano

Hi MT women, Your diagnosis is similar to mine. I have some questions. I am also debating in making decision on my treatment. Also worry about future

screening as well. Your mastectomy was not nipple sparing. Was there reason that you did not choose nipple sparing mastectomy? Are they allowing you to do MRI of blilateral breast? and if they do how often? My cancer was detected under MRI not mammo. But my surgeon tells me there will be no more MRIs because there is no indication. I didn't understand why she said that. I am thankful for finding it under MRI if not it could have gone to invasive DCIS. Its bit frustrating ....

MTwoman

Hi piano, I didn't choose nipple sparing as it was not an option. I originally presented with a lump that I found (I was 38 so hadn't started mammos yet). When I got my diagnostic, it was seen by both mammo and us. I had young/dense tissue and that lump lit up, so they didn't really see anything else. I got back the pathology from my lx, but got a second opinion (the first opinion was at my local hospital) because I didn't want anything to be missed. The second was an expert in DCIS, and his report suggested I get an mri to look for other tumors as the architecture type of my DCIS frequently presents itself multi-focally. They did end up finding 2 more areas in a different quadrant, one of them very close to the nipple. So then my BS said mx was what was recommended and there was no offer of skin or nipple sparing. I think with my young(er) age and the multi-focality, they were concerned that leaving more tissue would increase my risk of recurrence. I am 14 years NED, so I can't argue with their reasoning. As far as mri screening, I haven't had another one yet. I got mammos on the contralateral side every 6 months for 3 years, then every year. What I had discussed with my surgeon was getting an mri on the mx side, eventually, to check for recurrence, but we didn't set an exact year and I moved to Europe for several years and just moved on with my life. I didn't have an MO as I was TN, so Tamox was not recommended. So now, I am just followed by my ob/gyn.

So piano, you stated that your dcis was detected only by mri. What led you to get the mri? Did you have any symptoms?