TNBC Polls & Surveys - Insurance Coverage

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Insurance Coverage

Printed From: TNBC Foundation
Category: TNBC Forums
Forum Name: TNBC Polls & Surveys
Forum Description: A place to ask questions and survey the community
URL: http://forum.tnbcfoundation.org/forum_posts.asp?TID=8929
Printed Date: Mar 26 2026 at 6:17pm
Software Version: Web Wiz Forums 12.01 - http://www.webwizforums.com

Topic: Insurance Coverage

Posted By: Mary58
Subject: Insurance Coverage
Date Posted: Aug 23 2011 at 7:06pm

Has anyone ever had insurance deny MRI coverage? I received a letter today - saying they were denying it because it was investigational. Gee, I thought it was prudent - considering the TN diagnosis. Well, what is another battle - I hope we can win this one. Mary

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Dx: 1/10, 5mm, 1/28/10 SN negative, lumpectomy, 30 rads, no chemo.

Replies:

Posted By: 123Donna
Date Posted: Aug 23 2011 at 8:40pm

Mary,

I haven't had any problems with getting MRIs. I hope you can get them to change their minds. Can your onc petition the medical necessity of it?

Donna

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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

Posted By: Mary58
Date Posted: Aug 23 2011 at 8:53pm

Donna - Will try and let you know. Thanks.

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Dx: 1/10, 5mm, 1/28/10 SN negative, lumpectomy, 30 rads, no chemo.

Posted By: Sethsnana
Date Posted: Sep 12 2011 at 7:12pm

Mary58 wrote:

Has anyone ever had insurance deny MRI coverage? I received a letter today - saying they were denying it because it was investigational. Gee, I thought it was prudent - considering the TN diagnosis. Well, what is another battle - I hope we can win this one. Mary

I've had my insurance company refuse a PET scan, but not an MRI.. Insurance companies have absolutely NO clue as to what TNBC is.. It is very frustrating!

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dx 11/09 1.6 cm IDS (nodes clear), lumpectomy and mammosite radiation. ACx4 + 12 weekly treatments of Taxol, started on 1/5/10.
Completed Taxtol 5/19/10. CT scans lungs,liver clear 6/7/10.

Posted By: HappyGoLucky
Date Posted: Sep 15 2011 at 12:03pm

In NJ we are having difficulty adjusting to mandatory HMO selection.

My onc only accepts Americgroup and all hospitals and others accept Horizon NJ Health. I think I am in trouble. Frankly I am frightened.

Karen

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2/2009 7cm tumor, sent nod. pos. Lumpectomy 3/19/09,a/c dose dense+avastin clinical trial, taxol avastin stopped with pneumonia. 33 Rads 01/2010 ~ reccur 2011 supraclav.and internal mammary nodes. rad

Posted By: Barbi
Date Posted: Sep 15 2011 at 11:30pm

Let me just say what many of you know. Insurance companies are not your friends. They provide a service you have paid for, but they try their hardest not to pay claims that they might be able to deny. I have worked for insurance companies in a consulting role as a nurse, and had to remind myself on a daily basis of my code of ethics so as not to skew the truth the way they wanted me to. I know how bad this sounds, and I don't mean to make it seem like all they do is scheme to get out of paying, but we sometimes think of them as our saviours, when really we need to be aware of our contracts and understand much more than a layperson should be expected to. So many issues with them.

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10/10,age49,St3,gr3,5+cm,1 node,BRCA-,T+Cisplatin+Rad0001(or placebo),Lump 1+cm,AND 0/15,AC,rads finished 7/6/11.Mets bone, liver,mamm node 8/11,abrax/tigatuzamab failed.Started bicalutamide 11/16/11.

Posted By: 123Donna
Date Posted: Sep 16 2011 at 8:19am

Good point Barbi.

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DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

Posted By: HappyGoLucky
Date Posted: Sep 16 2011 at 8:28am

Barbi

I know from what u speak. My daughter in law works for a the largest ins provider. Can't tell u what bonus time is like over there. its a sin.

here in NJ medicare/medicaid has changed to a mandatory hmo. ii have a situation now but chose the most acceptable one to all hospitals and doctors groups. Justing made me so mad that my oncology group doesn't accept any other than amerigroup makes me sick.