6 years out - just denied MRI

They told me (they being the breast surgeon's NP) that I would never qualify for an MRI on the other breast, so I had it off prophylactically. I have CIGNA too. She seemed to think this was standard no matter what the insurance company from year one. With an undetected by mammogram ILC of 7 cm, I just had it removed. I did not have time or strength to research her statement since I was in chemo. Also, I was having problems with that breast right up to 2 weeks before surgery when they were finally able to biopsy two areas that were lighting up on MRI and prove them to be noncancerous. After all we go through, shouldn't there be some standard information that we can rely upon such as whether or not we can get detection that's reasonably expected to work? I feel for you.

I'm in the same boat with BCBS.  I'm triple negative and will be 5 years since diagnose this coming February.  I see the BS every 6 months for mammo and US.  My lump was found by mammo but never felt as it was 5 cms deep under the nipple so it was never felt.  For the first three years, BCBS allowed me to have a breast MRI every year then suddenly stopped me from having it.  My BS has fought them tooth and nail to no avail.  The reasons are absolutely ridiculous for their turning me down:  1.  I have had no reoccurrence or progression; 2.  No one else in my immediate family has breast cancer (even though I freaking have it!); 3.  I have no BRCA status to confirm that I need one (they refused to do my BRCA testing as I was 62 at time of diagnose with no family history); and 4.  it would be "merely investigational."  I cannot believe these idiots.  It is terribly frustrating and very stressful to me to know that my BS does indeed think it should be done every year, but two morons that call themselves doctors (and they are not even oncologists) can make this call on my life.  The saddest part of all this is that with the oncoming Obamacare - what else will they be cutting out on us?

Wow. I am just so…mad for all of you! How can they not give you targeted test? Oh. Do you have friends outside of the USA? Or could you take a vacation to Europe?

MRI is around 80 euro – to 250euro in Europe, depending on the country, and in countries like Croatia, Greece, etc (with really pretty see sides!) you don’t even need to have any kind of added cost for insurance, since tests are done in private clinics (if you are having difficulties, or your physician stated you had past difficulties, you can apply for free tests, but the waiting lists are about a month long). The plane ticket (that is bough in advance and has fixed dates) goes along the lines of 700- 800$, and trough agencies that book vacations it can all come off even better. In the end – your upper cost for the whole shabang is 900$ compared to the 1200$ in the USA (just for a freaking scan!), and you are also drinking a daiquiri and enjoying the sunset while doing it.

I know, I know, many of you are just unable to give up that kind of money (even if a few hundred are shaved off), but then again – if you were planning on a trip – here is something you can brainstorm about.

I wish you all well!

Curious to know if your situation has resolved since I am facing a similar dilemma.

Hi. Mine was caught in a routine mammogram but then MRI found a second tumor not seen on mammo. This past yr my ins co denied an MRI but they backed down very quickly when my surgeon wrote them a letter saying that MRI surveillance is the standard of care for ILC. Truthfully, this is now in Israel, where we now live and where they tend to take dr letters pretty seriously. Had I needed to I would have gathered up the money somehow to have one privately (about 2000 shekels/$600) and continued to fight for reimbursement. I couldn't stand that I had one minute of stress about this and was pleased that it was over quickly.

My husband is a dr and I used to help out in his office when we lived in the US, fighting with insurance companies. I couldn't believe how mean spirited they could be. How powerful. I hope obamacare helps reduce their arrogance and empowers the insureds. I wouldn't suggest removing a breast for this reason alone. I agree w the other women who live abroad who suggest doing it abroad and making a vacation out of it. Happy to help you if you want to visit here:)

also, have you checked out how much it costs to pay out of pocket in the US? Can't let these ins cos win on this one. How stressful!!!!

The other suggestion I'd make, and not sure if it would work, would be to call around to imaging (MRI) centers and explain your situation. Ask how much an MRI would be if paid for privately, given your situation. Not sure if it's still like this, but sometimes bills with original higher fees are submitted to ins cos with the hope of actually recouping less, even much less. Drs who participate w Hmos often have to accept much lower fees than they actually bill, and can't balance bill the insured for the whole remainder. it may be that they'd charge an individual less knowing that they didn't have to do all the paperwork (to end up with the same reduced fee anyway.) there is a section on BC.org on ins and others may have more experience with this. Just possible that you can negotiate a bit. Ask to speak w the office manager. Yucky stuff but fun to try to beat the system. Good luck.

Just spotted this and my heart goes out to you. I wonder if you can contact the insurance and tell them if they refuse an MRI, then you will have the doctor schedule surgery to remove the breast since mammograms are not good at detecting ILC. Either way, you can explain, the insurance company will pay...surgery, reconstruction, doctor follow ups. Which way do they want to spend their money? I also wonder if you can contact someone on local news that does follow-up and community issues who can escalate and draw attention to the issue. We should not have to fight this hard for monitoring our health!! We have suffered enough.

Best to you.

Hi emmacat,

Where do you live? Here, in Bulgaria MRI costs 150-200E. You can make it here, get the disk and bring it to whoever you want to make the interpretation.

I saw Mominie's post for the price of the MRI. She lives in Greece - you can go there, too.