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routine mammogram with ultrasound question

by elyssac, Nov 09, 2009 11:58AM
I am a 52 yo female who has dense breasts. Every year for the past 12 years I have had a mammogram with an ultrsound. New insurance company now will not pay for the ultrasound.  Can you tell me something that I can use in my appeal regarding routine mammogram with ultrasound to satisfy my insurance company? Please don't use the terminology of diagnostic because they don't consider a diagnostic test to be routine!

Your prompt response if greatly appreciated since my appeal review is on Thursday, November 11, 2009 at 2:30pm. I hope to be able to clear up this matter for future women requiring this test as part of their routine medical care.

Thanks,
Elyssa
Member Comments (2)

by iam1butterfly, Nov 09, 2009 01:40PM
To: elyssac
I think that if you get something in writing from your doctor that both details your pre-existing condition (the breast density) and states the justification for the ultrasound, it would support your appeal to continue having the ultrasound covered. Good luck!

by SueYoung55, Nov 10, 2009 05:33PM
Dense breasts show up white on a mammogram. So does cancer. So, it's kind of like looking for a polar bear in a blizzard. I had ultrasounds each time I had a mammogram and thank God I did since I ended up with invasive lobular carcinoma that does not show up on a mammogram bud did on an ultrasound. If you have any cysts or lumps or anything that can be the reason you get this test as well.

Good luck!
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