post treatment.... breast mri is anyone else in same boat???? HELP

e_hope
e_hope Member Posts: 370
edited March 2014 in Breast Cancer #1
okay ladies....

I am wondering if anyone else is in the same boat? My breast specialist is requesting annual breast MRI's (which I was well aware) My problem... The insurance company is considering this a major diagnostic test. Which I have a $5000.00 out of pocket deductible.

I am finding this unfair!!!!! Since they cover preventive mammograms at 100% with no out of pocket cost. Why should us woman who can no longer have the mammograms because of implants be penaltized

Why aren't my preventive Breast MRI's covered at 100%. Why should I have to choose to either one pay for the $2000.00 test or opt not to have it done.

I have already had my MD submit a letter to fight this and they will only cover it after i meet the deductible. NO good to me... So do to my current financial situation and the amounting medical bills i already have, I have opted to not have the mri this year.. Not really sure how i am going to pay for these test for the rest of my life!!!

Curious if any other of you are running into this situation!!!! Is your insurance companies covering it as preventative...

Anyone know any other avenues I can use to get these paid for???????

Comments

  • Marcia527
    Marcia527 Member Posts: 2,729
    #2
    I don't have implants but
    I don't have implants but the reason I'd need the MRI is because my cancer didn't show on the mammogram even tho it was huge. Follow up oncs only request mammograms. This doesn't make sense to me. I have a $5000 deductable also. This is why I'm not pushing for a MRI. It's also why I don't mind skipping mammograms. They wouldn't do anything anyway unless something could be felt. The only thing that I think you could do is apply for an appeal. Here is some info I found online: http://healthinsurance.about.com/od/claims/a/fighting_claim_denials.htm
  • seof
    seof Member Posts: 819 Member
    #3
    You could try contacting
    You could try contacting your local American Cancer Society to see if they could recommend any legal help. I really have no idea. Sorry you are having such a struggle. I have bilateral radical mastectomy with reconstruction via DIEP procedure. Dr. said not to worry about either one of those tests since there is no more breast tissue.

    I wish you well, seof
  • seof
    seof Member Posts: 819 Member
    #4
    You could try contacting
    You could try contacting your local American Cancer Society to see if they could recommend any legal help. I really have no idea. Sorry you are having such a struggle. I have bilateral radical mastectomy with reconstruction via DIEP procedure. Dr. said not to worry about either one of those tests since there is no more breast tissue.

    I wish you well, seof
  • swalters
    swalters Member Posts: 33
    #5
    Post treatment breast MRI
    E-help,

    I ran into this the first time I needed a post surgical MRI. I appealed and lost. Then I went before a review board to present my case, only to get a letter in the mail a few days later that again denied the MRI. At that point I decided I was going to have it done whether insurance paid or not. When the radiologist submitted the bill to my insurance company, they paid their fair share.

    The point is,if you keep taking the next step in the appeal process, you might get them to pay. Insurance companies make it as hard as possible, knowing that most people will just give up and they won't have to pay.

    Hope this helps. Good luck.
    Sandie
  • carkris
    carkris Member Posts: 4,553 Member
    #6
    swalters said:

    Post treatment breast MRI
    E-help,

    I ran into this the first time I needed a post surgical MRI. I appealed and lost. Then I went before a review board to present my case, only to get a letter in the mail a few days later that again denied the MRI. At that point I decided I was going to have it done whether insurance paid or not. When the radiologist submitted the bill to my insurance company, they paid their fair share.

    The point is,if you keep taking the next step in the appeal process, you might get them to pay. Insurance companies make it as hard as possible, knowing that most people will just give up and they won't have to pay.

    Hope this helps. Good luck.
    Sandie

    MRI's are good to have even
    MRI's are good to have even if not every year. My friend has an MRI and a Mammo every year. something every six months. My tumor did not show up on mammoogram. lobulars do not always , so an MRI os better. was your tumor lobular? this might help in getting the MRI
  • cats_toy
    cats_toy Member Posts: 1,462 Member
    #7
    I don't understand
    I have heard of lots of women getting mammograms with implants. Usually, if the mammo goes wrong, then the insurance companies authorize the MRI. So maybe that is they way you have to try it?
    Good luck with however this turns out
    Cat
  • Kgy
    Kgy Member Posts: 30
    #8
    cats_toy said:

    I don't understand
    I have heard of lots of women getting mammograms with implants. Usually, if the mammo goes wrong, then the insurance companies authorize the MRI. So maybe that is they way you have to try it?
    Good luck with however this turns out
    Cat

    I was told NO Mamo!
    I was told to never allow anyone to do a mamo on me now that I have implants they can break under the pressure of the mamo. That's what I was told anyways.
  • e_hope
    e_hope Member Posts: 370
    #9
    Kgy said:

    I was told NO Mamo!
    I was told to never allow anyone to do a mamo on me now that I have implants they can break under the pressure of the mamo. That's what I was told anyways.

    so was i
    I was also told mammos are a no no..... in mastectomy patients!! unlike augmented breast which can have mammograms...

    so no, Mammo's are not an option
  • Mama G
    Mama G Member Posts: 762
    #10
    e_hope said:

    so was i
    I was also told mammos are a no no..... in mastectomy patients!! unlike augmented breast which can have mammograms...

    so no, Mammo's are not an option

    e hope...
    How in the world could you have a mammo on a mastectomy? Do you mean the remaining breast?
    I'm scheduled for a mammo on June 29th, and I just assumed they meant on my remaining, lonely breast...
  • Angie2U
    Angie2U Member Posts: 2,991
    #11
    seof said:

    You could try contacting
    You could try contacting your local American Cancer Society to see if they could recommend any legal help. I really have no idea. Sorry you are having such a struggle. I have bilateral radical mastectomy with reconstruction via DIEP procedure. Dr. said not to worry about either one of those tests since there is no more breast tissue.

    I wish you well, seof

    Seof, even with a
    Seof, even with a mastectomy, you still have breast tissue. I hope you are going to be having some sort of tests in the future.
  • e_hope
    e_hope Member Posts: 370
    #12
    Mama G said:

    e hope...
    How in the world could you have a mammo on a mastectomy? Do you mean the remaining breast?
    I'm scheduled for a mammo on June 29th, and I just assumed they meant on my remaining, lonely breast...

    mama G
    I had a double mastectomy with reconstruction... So No mammograms are not an option.. I was responding to a earlier post when someone asked if mammogram was an option for me..

    My issue is breast mri is my only option to be checked for recurrence in the breast, and having a problem with the issuance companies..
  • Eil4186
    Eil4186 Member Posts: 949
    #13
    I am 46 and my breasts are
    I am 46 and my breasts are still very dense so in addition to mammograms, my doctors all want me to have annual MRIs. My insurance company does not even require a doctor's note. They cover the test 100%. But I am lucky, they covered my genetic testing with no questions asked also. I would ask your doc to write a letter saying that you must have the MRIs in order to catch any new cancer. That would actually save them money. I have never heard of anyone having a deductible for health insurance. I have 15$ copays for doctor's visits, but a deductible is ridiculous.
  • lnick
    lnick Member Posts: 1
    #14
    In the exact same situation
    I have been fighting with my insurance company United Health Care for MONTHS. I have one breast that is saline and one that is my skin. So, no mammograms. My onc. likes to have MRI's done on me once a year in place of the mammogram. Great, I love it, I'm on top of that. Then, I found out that this insurance company would not pay for it in full. I'm left with what's left. I have appealed twice. I get told that they paid according to my policy. Which I understand, however, my doctor has informed that the MRI is a medical necessity and they still won't pay. I 100% agree that the insurance companies should pay in these cases. Why should I be penalized because I don't have "real" breasts anymore???? I have no idea what to do except seek legal counsel. That is my next step if I call them tomorrow and get nowhere. At this point, I have already been sent to a collection agency for the amount owed, but I refuse to pay it. It is wrong what these insurance companies are doing and I personally don't want to pay every year in addition to my other bills for an MRI.
    What have you found out?

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