I know my suggestion may be difficult to do but I would call my insurance company to see if I can see another oncology practice for a second opinion.

Perhaps your breast surgeon can weigh in? ♥️

I am in NJ and I was under the impression that dense breasts= mammogram + ultrasound because a law was passed in 2014. I thought it was every state. If it weren’t for the ultrasound, they would not have found the cancer in the second breast which was invasive. My gyno would always write the script. My insurance covered it. Now I alternate ultrasound and MRI, but if I have discomfort, they will seek approval for MRI. It’s my surgeon’s decision and not the oncologist or the hospital where he is. My sister, who sees a PCP, has to argue every year and it’s written “if needed.” I always tell her that they can’t always tell when it’s needed. The second cancer didn’t show up on the mammogram. Mammogram detected one breast, ultrasound, the other.
I think there’s a difference between detection and survival.

I was scheduled for a routine mammogram until I mentioned a small lump in armpit. My PCP automatically changed the prescription to diagnostic mammogram plus ultrasound. The underarm lump was nothing but the two tests confirmed a small tumor in left breast. I had lumpectomy and clear sentinel node biopsies. My follow-up instructions from oncologist for the next five years include physical exam and blood work, including tumor markers, every six months and yearly mammogram plus ultrasound.

Maybe you can lobby for the ultrasound or get a second opinion. Maybe change doctors. I'd want every reasonable test that can be done especially if it's non-invasive and pretty risk-free.