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Breast Cancer Index: What's your experience?

Breast Cancer | Last Active: Oct 31, 2022 | Replies (44)
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@rpfricker

I'm new to Medicare this year, and it's been a challenge with them declining coverage for the annual mammogram, and prostate/PSA testing claiming the procedures were not coded as medically necessary. Mayo resubmitted (re-coded) the claim for the mammogram, and Medicare finally paid. The PSA has still not been covered.
I am, I believe, still cancer free after 5 years. I still need more education, so not sure about any difference in recurrence rates for men vs. women. I thought I had seen at one time that it may be higher in men, but not certain on that.

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Chris, Volunteer Mentor | @auntieoakley | Nov 5, 2021

In this context, I am an old timer as the BC index did not exist when I was diagnosed. They just knew I was under 40 with aggressive her2+ er+ so they hit me with everything they had available. Herceptin had not been approved yet for frontline therapy so I got that later with my first recurrence.
I am still too young for Medicare but I have tricare so it basically pays the same except that my prescription coverage is rolled in as well.
I can only imagine someone at Medicare looking at your annual checkup and scratching their head about PSA and a mammogram. Hahaha There were some coding issues with my husbands care at Mayo as well but they resubmitted and it was paid.
I am sorry you have to get mammograms that has to be uncomfortable. I would hope that Mayo has a really good mammo department. You are fortunate to be able to continue your care there.
I have a great doctor now, but in the beginning, not so much.
Did you have other treatments besides tamoxifen? How are you tolerating it?

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