Do I really need a diagnostic mammo?

adot99

Hi,

I'm hoping somebody here can help. I'm kind of out of resources. I had it easy - DCIS 5 years ago with lumpectomy and radiation. No issues since. I had one year where I went to get my yearly mammo and got sent home because it was ordered as screening and not diagnostic. So I've been careful to ask for diagnostic mammos since then. I just don't want to make an appointment and then get sent home. So, this year, I got another order for a diagnostic mammo.

The problem is that I got terrible new insurance this year and seriously can't find a place that will a diagnostic that also takes my insurance. I live in a metropolitan area of 3 million people and am striking out. I've gone back and forth with the insurance people, including escalations like 4 times now. I can't even get their web site to load today. I've cold called all over town. I signed up with a website that supposedly hooks you up with self-pay options and that failed. I'm kind of at my wits end. I'd like to get a mammogram because a) Uh, got treated for BC and b) I'm going to try to get my breasts fixed this year to correct the asymmetry and the surgeon wants it.

Asking my new PCP is no use. She was the only provider I could find that took my insurance and just gave me a blank stare when I asked for a diagnostic mammogram. I had to explain it to her. I haven't been to an oncologist in years because there didn't seem to be a need, so can't ask that person.

Has anybody bumped up against this? Is there a timeframe beyond which you no longer need a diagnostic mammogram? If I can just get *something* this year, I'll get better insurance next year. I just don't want to get sent home again.

moth

I can't speak to the insurance issues in the US but was told that after any breast cancer dx, even DCIS, every mammo after is supposed to be diagnostic and not screening. You can only use screening on women of average risk and anyone with prior dx is automatically at higher risk so needs the additional views.

flashlight

I'm wondering if it is the terminology. I looked at my last order Mammo Diagnostic Bilateral (3D mammogram tomosynthesis) Bilateral ultrasound if needed. Under associated diagnoses: my breast cancer history. Maybe your order doesn't have enough information on why you need it or the incorrect codes were used?

lisaleigh

I can only offer contact your old Oncologist and ask them if they will take your insurance and if not will the take you on with out, only to get diagnostic mam done. to put your mind at ease.

I am 5yrs out as well and was told yes you need dia., no explanation. For life =( sorry I dont have better news for you.

What state are you in? California has a breast and cervical cancer program that will help you pay for treatment.

adot99

Thanks for the replies, everybody. So happy to have this community. I saw your replies yesterday and decided it was time to get rude with the insurance company. They came back with another place at a hospital. Of course, that hospital won't take my written order, so I'm now waiting for my provider to fax it to them. Then we'll see if the insurance actually goes through.

I'm giving it 80/20 odds the insurance doesn't even pay for it anyway. So. Frustrating.

Again, I really appreciate you all!

MountainMia

I'm not clear on the issue at all. I was diagnosed with IDC 2 years ago. Last year and this year I had screening mammograms, not diagnostic. I know this because the hospital does "diagnostic" ones AT the hospital, and screening ones at the satellite clinic, which is where my scans were done. They are 3D, and I did have a couple of extra views of my cancerous breast done this time. I also have whole breast ultrasound done.

So what is different about diagnostic vs screening mammograms?

flashlight

This is what I read: You probably won't notice the difference between a regular mammogram and a diagnostic mammogram. A routine or screening mammogram consists of four views—two views of each breast. The technologist takes the pictures, checks them for quality, and then you leave. With a diagnostic mammogram (3D), you start with four standard views, and then supplement them with additional views, with an ultrasound and/or MRI as needed. A diagnostic mammogram is generally read by the radiologist right after it has been done and you know the results before you leave. For my last mammogram they did the extra films for each breast and I couldn't leave until it was read.

Most are doing the 3D mammograms for routine screenings as they replace the 2D machines. It is all so confusing.

MountainMia

So, flashlight, not at all clear, is it? By my understanding, the main difference might be whether or not the radiologist reads it immediately. So again, my screenings this year and last year were not "diagnostic," though they were 3D and I also had whole breast ultrasounds (ABVS) done both times.

adot99, maybe this will help you get scheduled correctly. Let us know what happens.

flashlight

https://www.breastcancer.org/research-news/3d-mamm...

adot99

Hey flashlight... can you repost that link? It cut off for me. I'm interested to see what it says.

MountainMia

This might be it

https://www.breastcancer.org/research-news/3d-mamm...

flashlight

Thank you MountainMia ! I don't know why it works sometimes and not others?

adot99 it sounds like a facility that has 3D mammograms will work for you with a screening order. I think somewhere on that order there should be a code for breast cancer. ICD 11 code for personal history of malignant neoplasm of breast ? V76.11. or a reason. I would think your insurance company would require the code like they do with blood work. Good luck!