As I've mentioned before, my mom battled and thankfully survived breast cancer approximately 30 years ago. In recent years, she tested negative for the breast cancer gene, but my sister and I are still considered at higher risk to develop breast cancer because my mom had it. Of course, that does not mean we will inevitably get it, but it does mean we need to be more cautious.
Thus I had my first mammogram was performed about seven years ago. I also see a breast surgeon for an exam every six months. The funny thing about mammograms, though, is the more you have over the course of your life, the more exposed to radiation you are in an area that should be protected from radiation. So while mammograms can save lives, they can also increase your risk of your tits being chopped off because you had so many mammograms. Damn, life is complicated.
Anyway, two mammograms ago, the radiologist suggested that I stop doing mammograms and have a breast MRI instead. The breast surgeon thought that wouldn't be helpful yet. My friend Dr. P (who is a colo-rectal surgeon - yeah, she cuts up assholes - ha ha ha) explained that MRIs are so sensitive that everything looks like it could be a lump and so many people wind up with unnecessary biopsies as a result. This year when I visited the breast surgeon, he prescribed an MRI for me.
Long story short, it was supposed to be on Tuesday morning, but the insurance company was "waiting for more information from the doctor," so I rescheduled it for tomorrow. Yesterday the radiology center called to tell me that the insurance company rejected the request. I can appeal the decision, and last night my mom offered to submit her pathology report on my behalf if it will help. Somehow I suspect the insurance company won't find it compelling. I guess I'll see what happens. They may think it is cheaper for me to get later stage cancer (as I may not be their problem at that point) than to pay for the fucking MRI.
And that my friends, is preventative health care in America.
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It's so nice how insurance companies don't pay for preventative care. I hate them for it.
ReplyDeleteoh how I could go into a tirade on this subject...
ReplyDeleteour insurance company sends out letter each month for weight management. they all discuss how very bad obesity can be for not only you, but your children and blah blah blah...then they deny to assist with ANY weight loss programs, surgerys, or medicine.
They also send emails touting about "smoking is horrible for everyone" but they denied paying for Chantix and all other stop smoking drugs.
they will also gladly pay for 2 visits to a therapist of their choice...after that the therapist charges are up to the patient.
I'm now positive my insurance company wants me to be a fat psychotic lung cancer patient before they will pay attention to me.
Our health care system desperately needs reform. People all over the country are telling each other some version of the story you just told EVERY DAY!
ReplyDeleteWell, I am now IRATE at my doctor, who is not willing to support my appeal of the decision if it means he has to "sit on hold waiting to verbally tell someone everything he explained in writing," which I don't really blame him for, but also don't appreciate the manner in which I was told he "just doesn't have to to sit around on hold and wait to talk to someone." Thanks a lot. You know, I don't really have time to be put on hold for 5-10 minutes every time I call the fucking office, but sometimes you gotta do things.
ReplyDeleteWhile it does completely suck that you are being denied an MRI, as a fellow high-risker who was also at one point told to get an MRI instead of a mammogram by her breast specialistm let me warn you that MRIs hurt in their own special way (needle in the hand with fluid pumped up it anyone?) and after I went through it was told by the lab people that I had to ALSO get a mammogram because the doctor at the place who did MRIs and mammograms (not, of course, my doctor) required I do both.
ReplyDeleteSigh.
(this is MC from London, btw. got myself one of those fangled blog accounts . . . )
Insurance companies are staffed by fuckheads. The end. I have had no end of troubles like this as well, and all I can say is that it pays for you to be an asshole right back to them. Sorry they're being difficult.
ReplyDeleteYour doctor is an asshole. Your life is not worth a few minutes of sitting on hold? @@
ReplyDeleteI'm so sorry. I hope this works out so you can have the tests and some peace of mind.
Mara - I hope that this means you'll be blogging soon! Also, I once had a pancreatic MRI, so I've done the whole fluid-in-hand-thing. It's not the pain, but the radiation that I want to avoid if possible.
ReplyDeleteKarrie - Yeah, I was shocked when the receptionist said that. To be fair, she did say that given the large number of people who are rejected for the MRI by their insurance company, he would never have time to do anything else. Still, the way it was said did not sit well with me and I may seek a new doctor.
Everyone else - thanks for the solidarity, although I must say that I wish no one else could relate to this situation.
My mom is a breast cancer survivor...and self employed. She pays $600 a month for insurance (for only herself) with a $10K deductible that covers NOTHING that could be related to breast cancer. 5 years of uninsured tomoxifin to decrease her chance of re-occurrence...sure, would you like my arm or my leg in exchange.
ReplyDeleteWhile I don't want to get into political debates, this is exactly what John Edwards wants to be covered in health care because he realises that it is cheaper to get checkup now, than to pay out big bills later after the fact. I would love to be able to go and get regular checkups but as one of the millions who have no insurance at all, I can not afford any health care.
ReplyDeleteWrite to the NY Department of Insurance. They will open an appeal. Make sure to submit your Moms pathology report, a note from your doctor, and write "genetically predisposed to breast cancer" in your letter of appeal. Ask for an "independent medical review"- that means that your insurance company will turn your case over to an external review board that is not related to your insurance company. If the review board overturns it, the insurance company has to cover it. Yes, it will take awhile, but once you get an approval it will be easyer to get them approved in the future.
ReplyDelete