Insurances do not pay for MRIs after Mx? How to follow up then?

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ailenroc
ailenroc Member Posts: 308
edited November 2015 in Surgery - Before, During, and After

In the first years after bilateral mx my surgeon had me do annual MRIs. Since 2013 nothing anymore because she says the insurances stopped paying for them and, oh, btw they aren't necessary.

I asked how I would ever become aware of a recurrence. Her answer: if you find a lump on your chest come and see me.

My best guess is that if I feel a lump underneath my silicone implants I'm by then already in deep deep trouble.

How are you girls following up? Are MRIs really unnecessary? How would I know if I have an implant rupture in my 7 year old implants? The Mentor (implant maker) recommendation was to follow up with MRIs every two years. But what if the insurances don't pay?

Advice please.

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  • BethL
    BethL Member Posts: 286
    edited October 2015

    This is a huge fear of mine. I'm getting ready to do a BMX vs UMX, and as part of my decision process I have wondered about keeping the healthy breast just so I can qualify for MRIs. But then again a MRI missed the cancer I was just diagnosed with. Thankfully I had a symptom - bloody nipple discharge.

    Seems we still deserve some type of screening - like you, I don't want to wait until I can feel it. I was told 10 years ago my chances of recurrence were minimal, well here we are again.

    Beth

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  • inks
    inks Member Posts: 746
    edited October 2015

    Maybe the plastic surgeon has to order the MRI to check the implants? I am 2 years out so far and no testing whatsoever - explanation- routine scans do not increase survival.

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited October 2015

    A lump would be less likely to occur underneath the implant since that is under your pectoral muscle, a local recurrence would be between the pectoral muscle and your skin.  Most who have had a local recurrence in their remaining breast tissue were aware right away since the skin/tissue layer is so thin the lump is obvious.  Implant rupture is a different matter, and you might have more success with a PS ordering the MRI to check implant integrity.

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  • owlwatcher
    owlwatcher Member Posts: 130
    edited October 2015

    I have been wondering the very same thing I am 3 years out and am wondering what my next step is. I will put this topic as one of my favorites so I can follow the comments.

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  • marijen
    marijen Member Posts: 3,731
    edited February 2019

    SpecialK these ladies are right. The way around insurance is to find another reason to do the procedure. You need medical people on your side, we all do.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited October 2015

    I'm in exactly the same place. MO just said you would "feel it". And that recurrence under the implant would be very unlikely.

    Insurance WILL pay for an MRI every two years to check for rupture of implants but that is NOT the same as checking for breast cancer because they do not use the contrast dye. I found all this out and still had the MRI because I had already reached my out of pocket maximum and thought I might as well test the integrity of the implants. The imaging guy did say it would pick up a large tumor I suppose, but I would probably be able to feel it at that point anyway He was very specific in telling me that this is NOT a cancer screening because they are not using the contrast dye. My MO did have to write it up as checking for the implant..and could not write it up for cancer screening.

    So yeah... there is nothing to be offered. Statistically it must be pretty rare so it's not worth the money for insurance companies to pay for it? Which honestly I am okay with. I try to do the self checks...see my doc regularly for checks too. I just feel if the damn beast is that determined to get me then it will. I don't want to walk around looking over my shoulder all the time.


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  • KellyAnne13
    KellyAnne13 Member Posts: 63
    edited October 2015

    SpecialK,

    FYI a lump could most certainly occur under an implant. It could occur on the chest wall. I work as a Nuclear Medicine Tech and we see metastases to the ribcage all the time.

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited October 2015

    kellyanne - thanks, I edited my post to reflect your info - my comment above was geared toward looking for local recurrence, a lump in the remaining breast tissue after mastectomy and implant reconstruction, rather than bone mets to the rib - which would be distant metastatic recurrence.

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  • Fitz33
    Fitz33 Member Posts: 243
    edited October 2015

    It's 5 years since my diagnosis and my BS has asked me each time before an MRI if my insurance has given me any problems and when I say no, she signs me up for another one. This is annually and when I get to the MRI location I fill out a form and state that I have noticed a change or have pain in one or both breasts and that takes care of the insurance coverage as they now have a good reason for an MRI. My BS said she would check with my MO as she thinks I could go to an annual mammogram now and discontinue MRI's since "the reoccurrence is less at 5 years" but my MO thinks it never diminishes so I'm not sure if the MO will want to order the MRI's from now on. My next appointment is January so I'll see then. I do know I'll be downright scared not to have an MRI since I'm still considered by my MO as high risk (i was 96% E+).

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited October 2015

    Interesting info Fitz33. I wonder if your MO is more diligent with you because of your higher stage? I just can't see them justifying it for lower stages with no lymph node involvement.

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited October 2015

    Somehow my onc has been able to get them approved yearly since my Bmx. She may play the family history card w the insurance co. I have one scheduled for Feb but BCBS canceled our policy so we may be forced into a lesser plan. I'll let you all know what happens and if approved I'll ask my onc how she does it. I'd be fine without it except for the rupture part which may convince me to deconstruct if they ever need to be replaced. I'm glad the tissue re: local recurrence is up front too. If other recurrence - oh well. I'll face that if it happens.
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  • Fitz33
    Fitz33 Member Posts: 243
    edited November 2015

    Susan, yes, I'm sure my MO is diligent because of the lymph nodes and will always consider me high risk. I had a lot of trouble with chemo and was on a trial drug with it and didn't start Herceptin right away so maybe combining all of that she never lets me forget that my 5 year anniversary doesn't really apply. I like to think it does so that's okay, I would rather the glass be half full and she remains diligent.

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