. asked in HealthDiseases & ConditionsCancer · 2 months ago

Stage 0 breast cancer, feeling pain but insurance won’t cover additional mammogram. Can they do this? Also how do I get a second opinion?

My mom was diagnosed was stage 0 breast cancer in 2019. They were able to surgically remove the cancer and my mom decided to not get radiation as the cancer was gone and it was near her heart. She is supposed to get a mammogram every 6 months and the last one she had in March everything looked good. But now she is feeling pain in her breast but is not due for another mammogram until September. She said her insurance won’t cover a mammogram until September. 

Can insurance really refuse to cover this if she is experiencing symptoms (pain)?Also, how does insurance work with getting a second opinion? Will patient advocacy at the hospital help us with making sure she is getting proper care?

5 Answers

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  • 4 weeks ago

    Stage 0 breast cancer is completely cured by surgery in over 99.9% of cases.

    Pain is rarely associated with breast cancer until stage 4.

    My own breast cancer (stage 3) was considered more likely to be a cyst because there was discomfort (not pain) until fully diagnosed and by that time is was the size of a golf ball and doubling in size each month.

    pain is more likely to relate to either a cyst or scarring from the surgery.

    She should talk to her doctor for reassurance.

  • Pippin
    Lv 7
    1 month ago

    Unless the cancer they removed was a particularly aggressive genotype, it's HIGHLY unlikely that she would go from NED in March to pain advanced enough to cause pain in July to untreatable by September.

    There are many things that can cause breast pain (including scarring from prior surgery) -- but early, localized cancer is not one of them.

  • LAN
    Lv 7
    2 months ago

    You are assuming that it's cancer with no evidence.  If she is really in pain then why doesn't she go to the emergency room?   This sounds like a bogus question to me especially since a mammogram isn't the only way to look for cancer.  They likely also only apply to regular mammograms and not ones ordered by a doctor as a needed extra.  

    Not to mention the fact that a hospital is willing to work with a patient to work on making payments as low as possible so a patient can afford them.  They also will help you fill out government assistance forms to see if it can be written off that way.

    Hiding behind a claim that you can't afford it is BS.

  • 2 months ago

    Uh......OK, you need a second opinion.  Stage 0 is a new diagnosis because we are diagnosing cancer earlier and earlier.  Having pain isn't a part of breast cancer, as far as I know.  

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  • 2 months ago

    First, get her doc involved to help justify the additional mammogram-sometimes that is all it takes: an explanatory letter.  Patient advocacy generally doesnt cover day to day regular doc's stuff like this; they do more like in hospital things, durable goods to go home possibly etc.

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