MRI not covered by insurance

momdeeco · 11-12-2007, 02:39 PM

My oncologist in Chicago recommended a MRI every 6 months alternated with a mammo every 6 months. My first MRI 6 months ago was covered by ins., but this one they aren't covering. Has anyone else had problems with this. Am I o.k. to do a MRI once a year? I am considering doing a double mastectomy so I don't have to fight with insurances and the worry of it all. My signature tells why the oncologist recommends frequent MRI's.

chrisy · 11-12-2007, 03:20 PM

You can appeal the decision, and have your doctor write a letter explaining why this is necessary. Getting either an MRI or Mammo every 3 months sounds like a lot, tho. Is this the plan for the long term or just a short time?

Getting a mastectomy just to not deal with insurance problems seems a tad drastic - although I know dealing with those folks can be very frustrating. Besides, that will cost them money too!

Linda · 11-12-2007, 04:59 PM

I agree that every 3 months may be overkill, and that's probably why your insurance co is balking. I had a partial mast and am high risk, and I go to a top breast specialist in LA. My followup is to see him every six months -- alternating mammo and MRI. If you do self exams, too, that should be enough. I've had no problem with insurance coverage (and actually my surgeon once added in an extra mammo of the cancer breast -- but I don't go more often than every 6 mos.)
Linda

Jean · 11-12-2007, 08:25 PM

Karla,
I have a digital mammogram every 6 months and alternate with an MRI.
Most insurance companies will only cover the MRI once per year.

You may wish to look into the BSGI, Breast Specific Gamma Imaging.
MRI in general costs almost $2,000 while the Dilon BSGI cost $500
this new test uses radiotracer uptake to detect cancer independent of tissue density. If you feel you need to test every 3 months you may want to consider the Dilon test. Google Dilion to find out who in your area has the new machine. Only two are in New York so far.

http://www.mayoclinicproceedings.com...sp?AID=811&UID=
http://www.dilon.com/
http://www.medcenterone.com/services...aCam/index.htm

momdeeco · 11-20-2007, 03:28 AM

I just received a bill for an MRI in May that this ins. isn't paying! I hadn't had a MRI since 12-05. Of course I am going to appeal it, yet it seems when I should be celebrating a 2 yr anniversay tomorrow, I in tears over ins. not covering recommended MRI and BSO. How can a doc that has never seen me be deciding my health care?

Brenda_D · 11-20-2007, 05:35 AM

Hi momdeeco. You should have your Onc write an appeal and explain why the MRI was necessary.

I also think the every 3 month thing is a bit much.
Can you point out why your Onc ordered it that way? Is it because you had to stop Herceptin?
If so, I would have them do a new Muga scan and see if you can get back on it now, since it's been awhile.

momdeeco · 11-20-2007, 06:48 AM

Brenda,
I think the reason of being so aggressive with the MRI's is because in 8/05 I had a normal mammo. In Nov. during SBE I found a lump. The mammo didn't catch it because of dense breasts. Also I am the 4th generation with BC on Paternal side. I have phone call into oncologist for her to write an appeal.

hutchibk · 11-20-2007, 10:14 AM

Yes! Appeal, because they don't expect you to. They expect an initial denial will just make you go away. Also, call your State Department of Insurance and get the address and dept. where you need to cc: the appeal letter to. Make sure you indicate that cc: on the bottom of your letter to the insurance company. Seeing that on the letter can really open their eyes and show them that you are serious, and they will also be required to justify their decision to the SDI, which will definitely keep them honest. This is how I got my second PET covered, which they tried to tell me was not necessary. Their response letter, which agreed that it would be covered, also explained the criteria in previously unknown detail, which in turn was able to help my doc get PETs covered for other patients with the same ins.