Determined Patient Wins Legal Fight to Cover Molecular Breast Imaging Procedure
NEWPORT NEWS, Va., June 2, 2014 /PRNewswire/ — When a health insurance company denies a claim, most people complain to their friends and family and then accept it, arranging payment methods or even denying themselves a procedure that may save their life. After all, what can one do to fight against the big insurers?
When Karen Larson from Golden Valley Minnesota, received the news that her new health insurance did not cover the Molecular Breast Imaging (MBI/BSGI) procedure as part of her surveillance program for early detection of breast cancer she put on her boxing gloves and fought!
After discovering a lump in her breast, Karen went in for a mammogram, but the results showed nothing suspicious. Karen learned that because she had dense breast tissue a mammogram may not necessarily be accurate so she was sent for additional testing. Karen’s breast cancer was later detected by MBI, an advanced technology shown by several studies to detect cancers missed by mammography. The MBI technology is provided by Dilon Technologies(®) Inc. based in Virginia. Since the MBI proved to detect her cancer, her doctors recommended that she undergo the MBI procedure as part of her follow up surveillance. Unfortunately, her health insurance did not cover the procedure, deeming it investigative and therefore not covered for all applications.
Karen spent weeks appealing the denial to her health insurance provider but was constantly denied. Determined, Karen appealed her case in the Office of Medicare Hearings and Appeals. The judge issued a positive ruling by overturning the denial. The judge’s analysis deemed the MBI procedure not investigational and therefore medically necessary for Karen. The ruling was forwarded to her medical insurance provider requesting them to immediately cover her MBI procedure. “I am doing this for myself, my sister, and the tens of thousands of other women for whom a mammogram alone is not adequate for breast cancer detection.” Karen added, “Women should advocate for themselves and should not take “NO” for an answer when it comes to early detection of breast cancer.”
Dilon Technologies(®) Inc. strives to improve the quality of life by providing a wide range of innovative medical solutions that benefit patients around the world. Dilon is a leader in diagnostic imaging with the Dilon Molecular Imaging Systems, high-resolution, small field-of-view general-use imaging cameras, optimized to perform Molecular Breast Imaging (MBI/BSGI) and localization for MBI-guided breast biopsy. Dilon’s cornerstone surgical imaging products, the Navigator(®) Probes, are one of the most widely used gamma probes for cancer surgery in the marketplace. The gamma probes offer a revolutionary upgrade option for 3D Tumor Imaging and Navigation with SurgicEye’s declipseSPECT camera. Dilon is the exclusive international distributor of Digirad’s Cardius(®) cardiac and ergo(TM) general molecular imaging cameras that provide outstanding image quality and increased patient comfort with a compact, open design. For more information visit www.dilon.com
Media contact: Pjerin Luli
SOURCE Dilon Technologies Inc.