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Sunday, October 25, 2009

I have a friend that just found out she has breast cancer. She needs and MRI because of another spot?

The spot is on her Liver. Her insurance won't pay because they say it's "Not Medically Necessary" Does anyone know how she could get help paying for one?? She needs help fast before its to late. Any ideas are welcome...
Answer:
If she's diagnosed with BC already, maybe you can skip the MRI and go ahead straight to a PET Scan. She could also talk to the hospital about a payment plan to pay for it.It seems if it's for Staging purposes, they'd have to pay for it.
If they wouldn't allow for an MRI, how is it known she has a spot on her liver? With breast cancer, any other diagnostic tests for suspicious areas would normally be covered by any insurance.
Every insurance company has a appeal process. A spot on the liver is medically necessary especially since there is already cancer present.There is also a medical review board that she could consult. I would do a search with the BBB and see if there has been any prior complaints. They will investigate the report and get back to her in a reasonable amount of time.I would think that she would have a valid reason to collect damages through the legal system if they don't comply. Many attorney's will take on a case for a percentage of the recovered monies that is rewarded. They will only do this if they have a reasonable chance of collecting for her.One should never stand still for this kind of neglect. I do know though if she has refused chemo they will consider that all that could be done for your friend has been done and therefore no follow up would be needed.I hope this helps.JoyceCall the insurance customer service personally and tell them that she needs someone to evaluate her situation.
I guess I was very lucky. My insurance company didn't balk at any diagnostic tests my doctors asked for. I too had a spot on my liver that was found during a CT scan but they were able to determine with ultra sound that it was just another cyst. They found several other cysts while they were doing all the scans. I did have an MRI of the breasts in addition to ultra sound, and mammograms and ended up having additional bioposies of 3 questionable areas on the right breast, they were all negative. It has been 3 years this week that I was diagnosed with breast cancer. If her doctor's feel the MRI is in her best interest, she can definately go through the appeal process at her insurance company.

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