High Risk Preventative Care

Hi everyone,

I’m 25 and didn’t expect to need to know this much about healthcare yet – please help.

Earlier this year my 27y/o sister was diagnosed with a rare, aggressive breast cancer and I tested positive for the same gene that puts me at 46% lifetime risk. Until I get a double mastectomy, my risk oncologist is screening me every 6 mo by Breast MRI with and w/o contrast. My out of pocket cost is ~2K a pop for these before ultrasound/biopsy of lumps they find. BCBS North Carolina has said that the MRI’s are not considered preventative (and therefore not covered) since I’m not 40+ and it’s not a regular mammogram. BUT it’s preventative for me. I am enrolled in the high deductible plan through my employer but still can’t afford to hit the deductible for bare, preventative measures. Is there a way around this or some code my doctor can enter for this to be covered? I was also presented with non-discriminatory paperwork when my genetics tested positive. Am I being discriminated against? Should I explore supplemental insurance?

I’m having a hard time finding a patient advocate or a customer service rep who understands the ask. Any advice is appreciated. I don’t understand our healthcare system well enough.

submitted by /u/herbfull
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