Insurers carriers are flaw in mammography

Dr. Anna Chen and Dr. Thomas Summers, in their Nov. 29 Another Voice, are right on with regard to mammography, which has significantly improved over the last few decades, as have the radiologists who read the images. It is the best, lowest-cost, mass screening tool we currently have, with limitations. When additional resources are needed because of these limitations, the more definitive tool in diagnosing breast cancer is MRI (MR Mammography). With regard to diagnostic breast imaging, the major “flaw” in the system is the insurance carriers.

I have been on the phone for an entire afternoon to get a patient’s breast MRI authorized, received approval from the insurance carrier’s physician (an internist in California) following a peer-to-peer review, only to have to jump through all the hoops all over again when I call the local carrier back. Are you kidding? Your expert physician just approved it, right there in your computer system, on your screen as we speak. It’s Friday, 5 p.m. Eastern time, sorry Ms. Smith, we couldn’t get your MRI authorized, so you won’t know if you have breast cancer until next week. That is if you don’t follow the insurance carrier’s algorithm that says you can wait six months for a follow-up mammogram.

Buffalo has excellent diagnostic breast imaging capabilities and radiologists who interpret them. Trust the patients, physicians and radiologists when this is needed, not the insurance carriers.

Michael Czech, RDMS