Cigna choosing not to pay for MRI's anymore.......

Any possibility that the BS just did not explain adequately to the insurance why MRIs are important in your specific situation? I just had a BS follow-up last week and she said that because I have 'extremely dense breasts' she would recommend MRI every 2 years.  So, I gather from that comment that regular MRIs are not the norm for everyone post BC.  But, I assumed from her comments that it would be normal for insurance companies to cover it in situations such as mine.

Let me also add: my hospital was giving me guff about MRI, and I went to get another opinion.  That doctor wrote a very strong letter saying it would be a shame for me to move all my care to another hospital over such a silly and simple issue:  MRI was the right choice for me.

So you might try a second opinion.

I think one of the key factors here is breast density.  I currently get MRIs annually but I know that the reason I do is because of my extremely dense breast tissue. 

Nada, do you know your breast density?  And was your DCIS initially found by a mammo, or was an MRI necessary?  I appreciate the desire to have an annual MRI - I am very glad that I get mine - however I believe that Cigna is acting within current guidelines in refusing your MRI if you do not have extremely dense breasts or if there is no reason to believe that a mammogram would not be effective with your breasts (i.e. if your previous DCIS was in fact found by a mammogram).  Your previous diagnosis of DCIS does increase your risk but I don't know that on it's own it's enough to put you at or above the risk level that's considered to be the bar for approval of annual MRI screenings. 

Here is what breastcancer.org say about MRI screening: Breast MRI for Screening

If you do have either very dense or extremely dense breasts, then that certainly should be part of the argument that your doctor uses with Cigna.  Same thing too if there are any comments by the radiologist on your mammo reports or MRI reports about a continuing need for screening MRIs. After my mammo, my radiologist always includes a note at the bottom of her report saying that I should have a follow-up MRI in 6 months and a follow-up mammo in a year. And on my MRI reports, the radiologist always notes that "continuing monitoring with annual MRIs is recommended". With those notes, I never have a problem getting the MRI scheduled (although of course my situation is different because I'm in Canada and don't have to deal with an insurance company).

Good luck getting this decision reversed!

Kudos to you and your docs for getting through the insurance company.  I have just hit my 4 year mark in February - I am triple negative Grade 3, no nodes - Stage 1.  Had a 1.2 cm nodule deep in right breast.  I have BC/BS you gave me no problems whatsoever with my yearly breast MRI ( I have mammo on my cancer breast every 6 months and both breasts mammo the next 6 months).  This year they refused to pay for the MRI.  My BS fought it diligently and even had a telephone peer to peer fight with the two bozo doctors at BC and still - they refused.  What is most troublesome to me are their reasons:

1.  I had no BRCA test done.  (That is true - because they refused to pay for a BRCA on me as I was 62 at diagnose and no family history of any cancer);

2.  My mother, my sister and my daughter do not have breast cancer, so therefore it is not necessary for me to have a yearly breast MRI.  (Never mind that I am the freaking cancer patient and not my kin); and

3.  It would only serve to be "investigative" at this point in time, so not necessary.  (Their exact words, not mine).

How do you even deal with idiots such as these two?  I find their reasons for rejection more insulting to one's intelligence than anything else.

Linda

Dear Amanda - Welcome to the BCO community. We are sorry that your insurance issues have brought you here. As you noted this thread has not been active in awhile and that may impact your receiving responses. Perhaps you might consider starting a new topic and posing your question. Good luck, The Mods

Well.  I had DCIS plus a microinvsion, seen on mammo (the DCIS, not the micro).  My HMO says they are doing the Gold Standard, as per the oncologist's group (ASCO, I think).  ASCO says that follow-up with just mammos is Gold Standard.  No US, no MRIs.  Also, the ASCO standards have not been upgraded in any real way for years. Then, they then send me the letter (mandated by law, or they would not have) telling me I have very dense breast tissue, and that mammos may not show more than 50% of BCs.  But that's it.  They send the informing letter, as the have to, but are not willing to give MRIs or even US for better screening.  Basically, they are telling me I now have a highly increased chance of a future BC, that mammo will not show half of those, but that they don't have to give me any other screening.  My first follow-up mammo is next month, and I have been trying to figure a way to insist on at least US, too.  Though I know what I'm going to hear.  And my HMO, Kaiser, is considered one of the best.  The SPIRIT of the law mandating letters informing women that their breast tissue is dense and that mammos may not show much was that, then, other screening would be offered.  But it was not WRITTEN into the law that they have to do it, so they aren't.  I, also, cannot afford these screenings outside my HMO (which costs enough, already).  Putting BC behind me, mentally, is hard enough.   I can do that, just, if I know I'm doing everything I can.  Without the proper screenings (for my case) I cannot feel all that can be done is being done.  I may need to make a campaign of my own, as the poor woman who died from a BC not seen on a mammo in her dense breasts did to get the informing law passed, before she died.  I  just don't know if I have the time or energy to do that ongoingly.  In fact; I know I don't.  I feel like asking my MO if it were she, or her mother or sister with the BC history and the dense breast tissue, if just mammos would be enough for her.  But I know what she'll say.  She (and the entire group there; any other one she could "refer" me to) will just say "We're doing the Gold Standard, as per the ASCO guidlines".  What to do?

And that's just about US.  Don't even get me started on the asking for MRIs.  And, yes, I would rather have the false positives and possible negative biopsies than another BC.

Hi Louishenry, I'm also with the "regular gals".  I have been since diagnosis in 2012, except for biopsy of other breast, so I had a 6 month follow-up for that side only (mammo only).  MRI's during the treatment year were related to something found on the other breast, not for routine follow-up.  Once the MRI was downgraded to a BIRADS-2, I'm on the mammo, sono annual schedule as well.  No MRI's and the docs didn't even recommend it (it probably would have been approved). Just gotta hope for the best. I always felt that the mammos had limitations (going back many years).