Topic: Will insurance still cover annual MRI's once we hit 5 year mark?

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Posted on: Dec 5, 2010 04:57PM

Posted on: Dec 5, 2010 04:57PM

Fearless_One wrote:

With grade 3 breast density, I wonder?   I worry about this, as mammos don't work on me and US's are not really used as a diagnositic tool unless something is suspected - I am 95% sure I want a BLMX, but just in case I change my mind I would want to know that I would still be able to get MRI's.     Just was curious....

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Dec 5, 2010 05:12PM mrsnjband wrote:

It should, especially if your doctor deems it necessary. NJ

Norma June, Bi-lateral MX 2008, Bi-lateral DIEP 2011 Dx 1/10/2008, IBC, <1cm, Stage IIIB, ER-/PR-, HER2- Chemotherapy 1/24/2008 AC Chemotherapy 3/9/2008 Taxol (paclitaxel) Chemotherapy 5/28/2008 Taxotere (docetaxel) Surgery 7/9/2008 Lymph node removal: Right; Mastectomy: Right; Prophylactic mastectomy: Left Radiation Therapy 8/10/2008 Surgery 8/14/2011 Reconstruction (right): DIEP flap Surgery 8/14/2011 Reconstruction (left): DIEP flap Surgery 12/11/2011 Reconstruction (left)
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Dec 5, 2010 06:06PM Fearless_One wrote:

I hear they are $4000 - $7000 (with contrast) depending on what state you live in if you had to pay for one yourself.  

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Dec 5, 2010 06:48PM changes wrote:

Fearless One,

That's a REALLY good question. I too have very dense breasts. Had my 6-month follow-up mammo and ended up BIRADS 3, just because they can't tell what they are looking at. Like you, I found the tumor myself and they had trouble finding it on the original mammogram, even with me pointing out the area. Disturbingly, at surgery they also found DCIS, that was not found on mammo, ultrasound, or MRI.

Karen

IDC Stage 1, Grade 1 Dx 5/14/2010, IDC, 1cm, Stage I, Grade 1, 0/1 nodes, ER+/PR+, HER2- Surgery 5/26/2010 Lumpectomy: Left Hormonal Therapy Radiation Therapy
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Dec 5, 2010 06:58PM Fearless_One wrote:

Karen, even the MRI missed the DCIS??  Wow, that is very disconcerting.   Did you have a BLM?   My surgery isn't until March, so that just leaves me weeks of angst and more questions that keep popping into my head...

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Dec 5, 2010 07:19PM eileen1955 wrote:

Part of the reason I elected to have a preventative BMX this past October is that it was exceedingly difficult to get a bs to push for insurance coverage for MRIs.      Another issue is that I am 55 and was told that I would not be allowed to have MRIs starting at age 65 (due to the dye and its effect on kidneys, I think) 

Like many of you I have very dense breast tissue and mammo never picked up my cancer in 2003. BS had difficulty finding it on u/s but I directed the scan to the area of "thickening".   It was invasive,grade 3, required chemo and radiation/lumpectomy.   I was numb and went thru that treatment plan; shocked that I had the cancer had appeared so mysteriously.

     I put it all on the back burner for 7yrs but this year I had a false positive MRI report; and I just re-thought my whole plan.  The thought of ever going thru chemo again was much worse than loss of my breasts.            For me the preventative bilateral mastectomy has given me peace of mind.    But that's just my story.      

Dx 10/28/2003, IDC, <1cm, Stage IA, Grade 3, 0/3 nodes, ER-/PR-, HER2-
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Dec 5, 2010 07:43PM Fearless_One wrote:

Eileen, I didn't know we couldn't have it after 65 or about the dye effect on kidneys - thank you for posting this.  I, too, had to "direct" her to suspicious area during ultrasound.   Had there not been dimpling of the skin and a palpable lump, I would probably would not be here posting .    Even now, as I wait for my sugery date, I feel another lump which we had biopsied which came back negative, but I still have this nagging feeling......

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Dec 6, 2010 06:49AM changes wrote:

Fearless One,

I had a lumpectomy, but during surgery the DCIS was found in the same area as the IDC. Now I wonder where else it might be, undetected. I talked to my surgeon at my last visit about a possible bilateral mastectomy. He said he would do it if I wanted, but suggested we wait 6 months until the next round of tests, and then make a decision. I really DON'T want to do the mastectomy, but I am fearful that tests will not catch anything going on. And since I've had radiation, reconstruction is likely to be a nightmare. So now we're doing "watchful waiting" and hoping for the best.

Karen

IDC Stage 1, Grade 1 Dx 5/14/2010, IDC, 1cm, Stage I, Grade 1, 0/1 nodes, ER+/PR+, HER2- Surgery 5/26/2010 Lumpectomy: Left Hormonal Therapy Radiation Therapy
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Dec 6, 2010 10:39AM Fearless_One wrote:

Karen, I feel as you do.   I have lost my faith in testing because of what happened.   I really don't want a BLM, but I feel certain something is going to come back and won't be found - I got lucky last time.   I noticed a dimpling of the skin.   Maybe next time it will come back deeper and won't be found.   Nope, I think I want my BLM.  

As for the recon, rads complicates it, but we still have options and I hear the lat flap is not too bad....

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Dec 6, 2010 03:06PM Fearless_One wrote:

Found out my last MRI (that insurance paid for) was $ 6900.00.    Yup, looks like I will still be getting the BLMX.   I can't take a chance that I will be having to pay those in 5 years - that's not going to happen.
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Dec 6, 2010 03:22PM eileen1955 wrote:

Last Nov 2009 I said to my BS (durning routine annual exam)"If I had it to do over, I'd go with dble mx rather than lumpectomy/radiation".          surprisingly, he answered "you are preaching to the choir. I am seeing too many recurrences"        wow, that stopped me in my tracks.   this is the same bs who said in 2003 that I was "overreacting" when I asked for a uni-mastectomy.

It's obviously not a decision to be made lightly-as you all well.    so in May 2010 I went for my annual extrememly painful mammo (pain is d/t trauma of radiaton from 7 yrs ago. I am apparently an unusual case, but that treated breast has been awful since radiation and lumpectomy which was really more of a half-mastectomy)           Mammo was normal; BS was refusing to order MRI even tho my 2003 was never picked up on mammo and breast density is still high.  so I switched to a different BS; this doctor has a PA who seems to spend most of her time getting insurance coverage for procedures.

Dx 10/28/2003, IDC, <1cm, Stage IA, Grade 3, 0/3 nodes, ER-/PR-, HER2-

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