Will insurance still cover annual MRI's once we hit 5 year mark?

Options

With grade 3 breast density, I wonder?   I worry about this, as mammos don't work on me and US's are not really used as a diagnositic tool unless something is suspected - I am 95% sure I want a BLMX, but just in case I change my mind I would want to know that I would still be able to get MRI's.     Just was curious....

Comments

  • mrsnjband
    mrsnjband Member Posts: 1,409
    edited December 2010

    It should, especially if your doctor deems it necessary. NJ

  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited December 2010

    I hear they are $4000 - $7000 (with contrast) depending on what state you live in if you had to pay for one yourself.  

  • changes
    changes Member Posts: 622
    edited December 2010

    Fearless One,

    That's a REALLY good question. I too have very dense breasts. Had my 6-month follow-up mammo and ended up BIRADS 3, just because they can't tell what they are looking at. Like you, I found the tumor myself and they had trouble finding it on the original mammogram, even with me pointing out the area. Disturbingly, at surgery they also found DCIS, that was not found on mammo, ultrasound, or MRI.

    Karen

  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited December 2010

    Karen, even the MRI missed the DCIS??  Wow, that is very disconcerting.   Did you have a BLM?   My surgery isn't until March, so that just leaves me weeks of angst and more questions that keep popping into my head...

  • eileen1955
    eileen1955 Member Posts: 365
    edited December 2010

    Part of the reason I elected to have a preventative BMX this past October is that it was exceedingly difficult to get a bs to push for insurance coverage for MRIs.      Another issue is that I am 55 and was told that I would not be allowed to have MRIs starting at age 65 (due to the dye and its effect on kidneys, I think) 

    Like many of you I have very dense breast tissue and mammo never picked up my cancer in 2003. BS had difficulty finding it on u/s but I directed the scan to the area of "thickening".   It was invasive,grade 3, required chemo and radiation/lumpectomy.   I was numb and went thru that treatment plan; shocked that I had the cancer had appeared so mysteriously.

         I put it all on the back burner for 7yrs but this year I had a false positive MRI report; and I just re-thought my whole plan.  The thought of ever going thru chemo again was much worse than loss of my breasts.            For me the preventative bilateral mastectomy has given me peace of mind.    But that's just my story.      

  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited December 2010

    Eileen, I didn't know we couldn't have it after 65 or about the dye effect on kidneys - thank you for posting this.  I, too, had to "direct" her to suspicious area during ultrasound.   Had there not been dimpling of the skin and a palpable lump, I would probably would not be here posting .    Even now, as I wait for my sugery date, I feel another lump which we had biopsied which came back negative, but I still have this nagging feeling......

  • changes
    changes Member Posts: 622
    edited December 2010

    Fearless One,

    I had a lumpectomy, but during surgery the DCIS was found in the same area as the IDC. Now I wonder where else it might be, undetected. I talked to my surgeon at my last visit about a possible bilateral mastectomy. He said he would do it if I wanted, but suggested we wait 6 months until the next round of tests, and then make a decision. I really DON'T want to do the mastectomy, but I am fearful that tests will not catch anything going on. And since I've had radiation, reconstruction is likely to be a nightmare. So now we're doing "watchful waiting" and hoping for the best.

    Karen

  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited December 2010

    Karen, I feel as you do.   I have lost my faith in testing because of what happened.   I really don't want a BLM, but I feel certain something is going to come back and won't be found - I got lucky last time.   I noticed a dimpling of the skin.   Maybe next time it will come back deeper and won't be found.   Nope, I think I want my BLM.  

    As for the recon, rads complicates it, but we still have options and I hear the lat flap is not too bad....

  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited December 2010
    Found out my last MRI (that insurance paid for) was $ 6900.00.    Yup, looks like I will still be getting the BLMX.   I can't take a chance that I will be having to pay those in 5 years - that's not going to happen.
  • eileen1955
    eileen1955 Member Posts: 365
    edited December 2010

    Last Nov 2009 I said to my BS (durning routine annual exam)"If I had it to do over, I'd go with dble mx rather than lumpectomy/radiation".          surprisingly, he answered "you are preaching to the choir. I am seeing too many recurrences"        wow, that stopped me in my tracks.   this is the same bs who said in 2003 that I was "overreacting" when I asked for a uni-mastectomy.

    It's obviously not a decision to be made lightly-as you all well.    so in May 2010 I went for my annual extrememly painful mammo (pain is d/t trauma of radiaton from 7 yrs ago. I am apparently an unusual case, but that treated breast has been awful since radiation and lumpectomy which was really more of a half-mastectomy)           Mammo was normal; BS was refusing to order MRI even tho my 2003 was never picked up on mammo and breast density is still high.  so I switched to a different BS; this doctor has a PA who seems to spend most of her time getting insurance coverage for procedures.

  • eileen1955
    eileen1955 Member Posts: 365
    edited December 2010

    I am purposely dividing this post b/c I "lost" two recent posts and don't know how to "save" midway.

    anyway MRI showed a 7mm "spiculated" lobule that lit up with dye.   BS practically told me it was defintitely cancer.    Radiologist did u/s and could not find it so I relaxed. But when I saw BS for next appt she starts in with "So you have another cancer. . ."      ended up having a breast MRI biopsy and it was negative. 

  • eileen1955
    eileen1955 Member Posts: 365
    edited August 2013

    so the final news was good but I had lost 3 wks of my life worried that I'd have to go thru chemo again.       In a way it was a blessing b/c it convinced me that I did want the bil mx done preventatively.    to me, the worst scenario was not losing my breasts. the worst scenario was finding another invasive cancer and having to go thru chemo again.   so, for my particular life, the decision was a "no brainer".

  • eileen1955
    eileen1955 Member Posts: 365
    edited December 2010

    Not that PBM is the right decision for everyone; but it was for me.

    So my assignment from that BS was to seek 3 PS consults since I was leaning toward no recon.  I met all three; amazing how they all tout only what they know.    the best of the 3 was Harvard-trained and not in my insurance plan. But he took the time to talk to me-twice.    He felt PS was state-of-the-art treatment for bil mx.     But he honestly portrayed a very difficult recovery d/t my having had radiation of the one breast in 2003.   

  • eileen1955
    eileen1955 Member Posts: 365
    edited August 2013

    He was brutally honest; and I am so grateful.   I have had a lifetime of surgeries due to a congenital vein problem.  I just could not see myself going thru more surgery and risking poor blood supply to tissue taken from my back; while dealing with TE on the opposite breast.(my recovery from PS was not affected with my congenital problem)  It just gave me pause.

    In a nutshell, it's all about disovering who you really are.  I am 55 and I really did not know but then it became clear to me.    Am I a person to go around flat w/o my beast prosthetics? No, that's fine for some women but not for me.          

    Okay, enuf about me.       

  • changes
    changes Member Posts: 622
    edited December 2010

    Fearless,

    My MRI was nowhere near that expensive - came in around $2300 - wonder why such a difference?

    I broached the reconstruction option with my surgeon - the only one that sounds okay to me is DIEP but no one in my state does it, and it is just not practical for me to go to New Orleans, bringing a caregiver along with me. Also, my surgeon said it is EXTREMELY expensive and insurance may not approve it. The lat flap kind of makes me cringe. My surgeon thought a skilled plastic surgeon might succeed at straight implants, mainly because my radiated skin is healing reasonably well. Ah, well, this is one decision I can put off for awhile. Maybe in 6 months I'll be less freaked out by the unreliable testing situation.

  • eileen1955
    eileen1955 Member Posts: 365
    edited December 2010

    there are newer 3T MRIs that cost more. Maybe that's why you were quoted a lower price. Even my insurance company's negotiated contract amt was not that low. But we have 3T.

  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited December 2010
    Karen, I assume yours was with contrast?   They are cheaper if they don't use contrast (but not as reliable).  Eileen, yes, there can be many false positives with and MRI  - but at least that won't kill you like a false negative can (such as with my mammo).   And no, I wouldn't wear a prosthetic, either - I mean, that's fine - to each her own - but I wouldn't unless I had no reconstruction option - and I mean none.
  • eileen1955
    eileen1955 Member Posts: 365
    edited December 2010

    Fearless one; I totally understand your point on the MRI and recon issues.      I hope I was clear that I am just happy that I found what was right for me.   It's that searching process that I was trying to describe.  the end results are all different and all to be respected.

    False negative mammo is way worse than false positve MRI.   I've had both and I totally agree. 

     My only point was that I didn't sleep for many nites d/t the false positive on MRI.   And for me, that clinched my decision to do prev bi  mx.      

    I wish you all the best in making the decisions that are best for you.      

  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited December 2010

    Eileen, it's okay - I totally understand - I would not have slept a wink, either, if I had a false positive.   That would certainly impact one's decision.   I'm sorry, I am still confused - you did have the mast.  or you decided not to ?

  • eileen1955
    eileen1955 Member Posts: 365
    edited December 2010

    I had the preventative bilateral mx two months ago. tough recovery; but I am so glad I did it.

    I see you are planning BLM yourself; please feel free to PM me with any questions.  Like you, my cancer was not visible on mammo and bs could not find it on u/s till I directed him by holding the breast up.   freaked me out.       when I had the recent scare, NO ONE (in medical profession) was the least bit surprised that I would have an invasive bc again.   

    I'm relieved and doing very well.   

  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited December 2010

    Eileen, I am glad you are doing well.   So you had recon?   What did you get?   I am curious, since I had rads, too.   Yeah, I can't take the chance that 4 years from now my "screening" options are going to be limited to mammos and US's.   That is just not good enough for us dense breast ladies.   If I didn't have dense tissue, I probably would not be having the mast.

  • eileen1955
    eileen1955 Member Posts: 365
    edited December 2010

    No recon. I can see why my post on that was confusing, b/c I spoke about it in the hypothetical stance.  sometimes I think I need an editor!          

    So No, I spoke to 3 PS and decided against PS.   I am such a maverick!!   Boy, did they try to push it on me.          Two of the PS were like used-car salesman; trying to sell me what was on the "lot" (i.e. the procedures they knew)    the third PS was like a BMW salesperson.  High class; trying to impress me with all the new advancements.

    If he could have, I think he would have asked me to take "a new model" for a spin around the block!       Ha-ha!             

    on some level; there is revulsion of a woman who chooses not to have her breasts replaced. I'm not kidding.        The nurse at my bs office chided me "to at least go for TE's. They are so much better than NOHING"                    But PS does not fit into my lifestyle.  and, no, it's not like I'm leaving this decision for a future date (I get a lot of that) b/c the "BMW" PS was quite clear that it was now or never.  I respected his feedback greatly.     I would recommend him in a heartbeat to any woman who wants breast recon and has big bucks.             But he layed out the truth; and the thought of being in ICU with my breast temperature being monitored was not what I wanted.

    I have spent too many nites in ICU in my life dealing with my congenital vascular condition.  all I can say is I am very happy with the choices I made.   My husband and I strolled around Rockefeller Center yesterday and celebrated that I am recovered from my surgery.  Our marriage is in no way rocked; perhaps we are even stronger.         So that's my story. eileen 

  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited December 2010

    Eileen, sounds like you have yourself a good man!   I am glad.   As for the recon, so be it.   You are alive and well and that is all that matters.  

  • dreaming
    dreaming Member Posts: 473
    edited August 2013

    There is really no 5 years mark, for B.C. I am 17 years from diagnosis and now my doctor orders an MRI once a year.

    Before I would get the mammogram and ultrasound yearly.

  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited December 2010

    Dreaming, that is great that you are still able to get those - and the insurance company never denied it in all those years?

Categories