Insurance declined MRI what else can be done?

I've had this lump for 10 months now, palpable by myself and my ob/gyn, not detected on 2 ultrasounds. I can only feel it when I lean foward, it's under my areola, the doctor can feel it more lateral when I am lying down.It can be very tender and never goes away. My insurance declined an MRI what else can be done to know if this is harmless? Is there any bloodwork? The doctor had mentioned a surgical consult, but how can he biopsy something not found on ultrasound? I am 29, small chested and am planning a 2nd baby. Family history includes paternal aunt and great grandmother with breast cancer and I think my mom had cervical or uterine cancer. Does the paternal side matter?

[Cleveland Clinic]

Dear KeyD:  Next steps depend upon how suspicious the doctor is about the lump.  If he/she is not suspicious, then MRI may not be necessary.  Did they mammogram?  If there is suspicion, I would think your doctor could argue with insurance on your behalf.  You may want to see the surgeon and get his/her opinion of whether MRI would be helpful.  MRI has a very high incidence of false positive and often leads to unnecessary biopsy.  A second opinion may be helpful in this case.

[Marylou_II]

Well this is another prove of how the insurance companies act when they can save money with the denied MRI. Have you asked your doctors the same question you are asking here? Well do so and ask them for an alternative to an MRI, if they don't know no one else will. From the many posts I have read most MRI tests are being denied unless they have a mammogram that shows some type of very malignant tumor. So I am to understand that insurance companies are waiting for things to get out of hand to then authorize and MRI.

I understand you already had a mammogram, ask your doctor if a Thermography is more sensitive than a mammography and will thus show what ever is not shown in the other tests. Don't worry about radiation Thermography does not have radiation.

If you happen to be finally authorized to have an MRI, the MRI itself is not dangerous but be very careful with the contrast agent they inject before the MRI, a new illness has been discovered and it is called Nephrogenic Systemic Fibrosis, NSF caused by the contrast agent that has the highly toxic metal called Gadolinium. Google it so you will have the full information and as I always say don't trust anyone.

Good luck.

[KeyD]

thanks for the info. I spoke with my doc office today and they said the insurance co. are denying more MRIs then they accept and you pretty much need a + biopsy before they approve it....something is wrong with this system. I have an appt with a breast surgeon in 2 weeks for a second opinion. I haven't had a mammo, just 2 ultrasounds that didn't show anything.

[Marylou_II]

This is something that makes me very angry, no MRI as being denied to most patients, of course you are not thinking on having a biopsy that would be ridiculous, a biopsy has its reasons and its moment it is not an MRI replacement. MRI s are done in conjunction with mammos  and to tell you the truth my MRI s were good for nothing. I never saw the radiologist or surgeon look or mention them at least once.

There is nothing wrong with the system, what is absolutely wrong is that they are saving money with peoples lives, ask for a certification that the MRI was denied date and all, I would love to see their faces, insists until you get it don't let them corner you and fight back. We have to stop being scared and learn to fight back for our lives.

I hope you have the fighting spirit and do it. Good luck.

[katarina777]

I do agree with the Cleveland doctors about having a second opinion; it's more important at this moment than having an MRI. And most likely, you do need to have a mammogram first before a MRI is approved.

But the bid difference consulting with a breast surgeon will make is that if he/she recommends an MRI, this will much more likely be approved coming from a surgeon.

Don't give up yet. if the surgeon agrees a MRI is necessary, he/she will approve it. And if a MRI is not necessary, then he will communicate this to the Insurance company and they will not approve it, and/or first approve a mammogram which really should be the first step, I cannot imagine a biopsy being recommended without mammogram but I may be wrong, and the surgeon may feel he can do a needle aspiration without seeing it on a scan, and I also do think that is possible in your case. (if the doctor says so) kat

[katarina777]

You should also consider the possibility, if so recommended by a breast surgeon, that MRI is not necessary, and that it's not only a rotten system at play.

i.e. it is uncommon for cancerous lesions to be painful but this is much more common with cysts.

[katarina777]

PS: also, MRI isn't perfect. there are many false positives, I hear, but in my case it did not detect any of my cancerous lymph nodes and of which there were plenty. my surgeon told me MRI was notoriously unreliable in showin accurate lymph node status.

[Ma111]

An MRI did not show my primary tumor. I had 2 MRIs before surgery. The surgeon can also work on getting one approved if she thinks you need one. It also did not show the nodes that I found in the axillia. My Mammo was -. Ultrasound/pet-ct showed the nodes.
What did your mammo show?
Did your aunt have genetic testing done? If so and was positive for bcra 1, this would help get things approved.

[KeyD]

I have an appt with a surgeon next week, she is chief of the Breast health dept at my somewhat local hospital. The same hospital that the MRI would have been done at since my local hospital doesn't have the expertise. I agree that if she feels it is necessary then she'll push the insurance co to approve.

[Ma111]

Good, sounds like you will get the care you need, thanks for the update.

[KeyD]

saw the dr today, she thinks the "lump" is a ridge of tissue and nothing to worry about.