Navigating health insurance can be quite daunting, especially if you’ve never dealt with a health issue before. Evaluating plans, figuring out what’s covered, getting authorizations and pre-approvals for surgery, imaging or 2nd opinions — all of this on top of a DCIS diagnosis can put one into overwhelm. Anti-anxiety meds like Xanax are often covered, but acupuncture, biofeedback and yoga classes most likely won’t be. A mammogram every six months will be recommended and covered, but annual MRI monitoring is usually only covered if you are considered high risk (at least a 25 percent lifetime recurrence risk). Thermograms are generally not covered but it doesn’t hurt to try. Naturopathic healthcare, nutrition counseling, supplements and other natural prevention methods and practitioners are generally not covered by most insurance companies. However lab work, bio-identical hormone prescriptions and integrative MDs may be covered.
And then there are those that do NOT even have health insurance when diagnosed! How do they afford the enormous cost of treatments?
Please share your experiences with health insurance below so that we may learn from one another how to best navigate the system.
I am self-employed and have a grandfathered health insurance plan with a high yearly deductible. Mammograms, well woman exams, paps, anything preventative and prescriptions are not covered until that deductible has been met. My policy is exempt from the new health care laws, however it is my choice to keep it. Now that I have a history of DCIS, my MRI ‘s have been covered this year only because the deductible from having three breast surgeries in 2013 was met, however must start all over with the 2014 calender year for my six month MRI/mammogram coming up in April, 2014 meaning I will have to pay out of pocket (hopefully my deductible will not have met by then, in fact I hope it never gets met again). Even though MRI’s typically cost approximately 10 times more than a mammogram, it is worth it for me because MRI’s detect things way before a mammogram does, but should not be used as a substitute for mammogram…they need to be performed at same time for accurate comparison results.
Thank you for your words of wisdom re MRIs. I couldn’t agree with you more. Even though an MRI typically costs approximately $2000, they are totally worth it. This is especially true if you can get an Aurora RODEO MRI, which has a false negative rate of 1 percent and an equally awesome false positive rate of only 11 percent.
I wondering if there is any help financially regarding radiation therapy? I have medicare and the Dr’s office want $3,000 up front just for a consult. It’s very stressful. I Had DCIS with zero margins non hormonal. Do I really need radiation?
I don’t know if there is any financial help for radiation. You could try calling your local American Cancer Society and see if they know of any.
If you don’t think you want radiation, it might be worth the $635 out of pocket Dr. Lagios charges for a pathology review (not covered by Medicare). He will use the Van Nuys Prognostic Index to determine if he thinks you need radiation.
The Oncotype DX is a genomic test to determine the same. Although it costs over $4000, I think you can apply for a scholarship and I know people who have had all of the cost covered.
For more info on the value of radiation therapy, please also check our page on RADS:https://dcisredefined.org/choices/rads/.
Remember because DCIS is non-invasive, you don’t need to rush into anything you don’t feel comfortable with.