Since mammography is considered the “gold standard,” it can be challenging to obtain an ultrasound without mammographic x-ray and with insurance reimbursement. Drawing on the “collective wisdom” of client testimonials, here are two common challenges you may face and suggestions to overcome them.
- How do I get my doctor’s support?
- How do I get insurance to pay?
How do I Get my Doctor’s Support?
When you step into your doctor’s office, do you feel that their “protocol” is overwhelming your ability to express your preferences? Do you feel intimidated or uncomfortable? Does it feel like it’s just not “worth it” to try to sway them because it will fall on deaf ears?
When your doctor says “it’s time for your mammogram” this is your moment. Stand firm. Consider saying, “I have had a thermogram to study physiology, but I want a completely safe anatomical test too. I decline mammography and ask for your support for an ultrasound. Can you help me with a script?”
Another approach: consider explaining that you’re seeking a complete picture of your breasts and have the physiological view by way of advanced thermography (for which most doctors misunderstand or disclaim as experimental) and that you’d like to add a completely safe anatomical view by way of ultrasound. “I choose to decline mammography but request an order for ultrasound.”
How Do I get Insurance to Pay?
Women report that their insurers say “mammograms before ultrasounds.” However, mammography is not for all women or all situations. Insurers may cover the ultrasound without a mammogram, but require a properly-coded ultrasound script/doctor’s order.
Once you have your doctor’s support, “help them help you” by suggesting the use of diagnostic codes (ICD 10 codes) on the ultrasound script/order appropriate for you and your situation:
- Dense breast tissue: Z12.31 (if no mammography) or R92.2 (with mammography) and Z80,3 if family history of breast cancer
- Breast implants: Z98.82
- Pregnant: Z33.1
- Nursing: Z39.1
- Intolerant to radiation: Y84,2; resulting in Fatigue – R53.83, or Nausea R11.0, or Dermatitis L30.9, or Pain R52
Requesting support for an ultrasound order may be easier than you think. If you see an OB-GYN or doctor who is very locked into “protocol,” consider enrolling a Nurse Practitioner, Physician Assistant or Certified Nurse Midwife (even if you’re beyond childbearing years, as they are skilled in women’s hormone health and are usually very open minded).
Helpful Tips:
- Choose ultrasounds at independent imaging centers rather than those in hospital settings, where protocols are more strictly enforced. Consider the approach: Show up. Decline mammography. Present your doctor’s order.
- Never discount that you have the right to decline any medical service and that you are your best advocate. Fear of self-advocating in front of the doctor? Consider: Just Say No. Be Your Own Advocate.
- While the before-mentioned ICD 10 codes should be justification for insurance to authorize and pay for the ultrasound, if they do not, some ultrasound providers accept self pay, including HerScan, where no script is required.
In Summary:
Advocate for what you want. Help your doctor help you. The needle is moving regarding patient-centered care: consider having conversations with your health care provider about getting a more complete picture of your breast health with thermography and ultrasound.