insurance coverage question/breast MRI

ohilly
ohilly Member Posts: 441
edited March 2014 in Breast Cancer #1
I have already had invasive intraductal cancer in my left breast (small tumor, did not spread to lymph nodes) and in Sept. will have a preventive mastectomy on the other breast because I have the BRCA gene. I asked several doctors about getting a breast/chest wall MRI after the bilateral mastectomy because I am paranoid about getting cancer again. All the doctors agreed that it is not the standard of care to get an MRI after a bilateral mastectomy, they just palpate you. However, finally my breast surgeon agreed that she would write a script for an annual MRI (while still telling me that it was not necessary - that the only monitoring will be palpating me), but she emphasized that it will not be covered by insurance and the test costs $5000. So my question is: has anyone had insurance cover an annual MRI for monitoring after a bilateral mastectomy and how did they get the insurance to pay for it? I am also wondering what people think: is it worth to pay out of pocket for an annual MRI, does it really tell you more than just palpating? I don't want to pay so much money out of pocket, but on the other hand, my life is worth it. Please advise! Ohilly

Comments

  • Unknown
    Unknown
    #2
    ohilly, i've had several MRIs but I don't think they are that expensive here in NY. My BRCA genetic testing cost around $4000 and that is about one of the most expensive tests there are. MRIs are pretty routine..... I have heard of BRCA positive women being monitored with mammogram and MRI biannually or annually. I don't know about the masectomy part though. I know some docs that use ultrasound in conjunction with the mammograms too. With a bilateral masectomy though, you should try to remember that they have removed everything and, your tumor was small with no lymph node involvement. Why put yourself through an MRI every year? The doctors are choosing a plan for monitoring you that is proven AND standard. I think with time you will begin to be less fearful.
  • cabbott
    cabbott Member Posts: 1,039 Member
    #3
    My mastectomy seems pretty flat and easy to palpitate. If anything showed up in my chest wall, I'd know pretty much right away. You could easily and cheaply get that kind of training. A friend had a second lump found two years after her first mastectomy. It was an infected lymph node way under her collar bone. She said she never knew to check that high, but the doctor did. They did radiation after surgery and she is doing fine thank you, 20 plus years later. Catching a tumor while it is less than 1 C. is a good idea, but you have a very small chance of having any tumor develop and a very good chance of catching it if it does, especially if you get training. I really learned a lot from a surgical nurse that spent fifteen minutes showing me how to do a thorough breast exam. I also learned what cancer felt like by working with my local breast cancer coalition. They had silicone models you could feel to find the cancer. They said they took them to high school classes to train the boys. Talk about covering the bases! You could also consult with a top-notch breast specialist radiologist on how much an MRI can find that your own trained fingers might miss. Another thing to keep in consideration is the level of medical treatment we currently have. Unfortunately, there is a limit to what doctors can do even if you catch a met or a tumor super early vs. later. You already know what they can do if they catch a small tumor vs. a large one. I have never had an MRI and don't plan to get one, but I do understand that you would like to feel safe. Good luck!

    PS Did you already have your ovaries out? That is another way to lower your risk and if you are estrogen positive, it gives you options other than tamoxifen to better your odds.

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