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3T if you were me???
Here's the deal. When I had the open MRI of my brain, my insurance paid 100% of it. The MRI was a Hitachi Airis Elite. Their website says it has a 0.3 Tesla vertical field magnet. I had one small lesion. When I had my c-spine done at the hospital in a closed one (strength unknown), I was responsible for about a grand, I just found out today. Of course, you find things like this when the customer service department isn't open, so I'll have to call them this week to make sure I understand the difference, but I think it's because it wasn't a freestanding MRI place. Spine has 3 lesions.
It seems that the in-network outpatient facilities nearby are all open MRI places, so I'm sure I can't/won't go to any of them in April when I get the next set. That means I'm going to be paying another grand at least toward my enormous deductible--that's a given. I know of one 3T machine in town, but it only does brains. The picture on their website shows a person sitting upright with the machine on top of her head like a gigantic Carmen Miranda headpiece. They do functional MRIs there, and she's looking at some vision test. I called them and verified they can't do spines on it.
So the question is, if you were me, would you make two trips for MRIs in order to have the brain on a 3T, knowing that the deductible will be quite a bit higher than if you just did both in one fell swoop somewhere else? Or would you say to yourself "I'm already most of the way there, and if I get a 3T image, I might get the diagnosis over with sooner--plus the spine set will push me out of deductible country and into co-pays?" Unless I misread the Hitachi site, it would be 10 times stronger!
Kinda premature, and sort of academic, as the hospital downtown by the neuro's main office might even have a 3T and they just don't brag about it on their website? Both hospitals are affiliated with medical schools and somewhat with each other, and they're blocks apart, so I kind of doubt it. Is this worth asking my neuro about? I'm pretty sure if I don't, she'll default to the hospital where I've been going.
So, step into my size 11's and give me your thoughts? Thank you.
Holly
It seems that the in-network outpatient facilities nearby are all open MRI places, so I'm sure I can't/won't go to any of them in April when I get the next set. That means I'm going to be paying another grand at least toward my enormous deductible--that's a given. I know of one 3T machine in town, but it only does brains. The picture on their website shows a person sitting upright with the machine on top of her head like a gigantic Carmen Miranda headpiece. They do functional MRIs there, and she's looking at some vision test. I called them and verified they can't do spines on it.
So the question is, if you were me, would you make two trips for MRIs in order to have the brain on a 3T, knowing that the deductible will be quite a bit higher than if you just did both in one fell swoop somewhere else? Or would you say to yourself "I'm already most of the way there, and if I get a 3T image, I might get the diagnosis over with sooner--plus the spine set will push me out of deductible country and into co-pays?" Unless I misread the Hitachi site, it would be 10 times stronger!
Kinda premature, and sort of academic, as the hospital downtown by the neuro's main office might even have a 3T and they just don't brag about it on their website? Both hospitals are affiliated with medical schools and somewhat with each other, and they're blocks apart, so I kind of doubt it. Is this worth asking my neuro about? I'm pretty sure if I don't, she'll default to the hospital where I've been going.
So, step into my size 11's and give me your thoughts? Thank you.
Holly
Well, I'm getting it done April 2--Yay, just a month and a half to wait now. When I called the scheduler, she said "If the purpose is to see if there are changes, it would be better to do it on the same strength machine." I said, "Since this is going to cost me over $1000, don't you think I should get the best picture that money can buy?" I didn't bother telling her it would be an increase in strength even on a 1.5T, at least for the brain. Then I gave her the phone numbers and she arranged it.
In researching this place (it's a freestanding doctor-owned specialty hospital--outpatient surgeries, overnight stays, and the like) I found that they have sued all the hospital systems in the region for conspiring to keep them out of preferred provider networks in a Sherman anti-trust action. They've settled with the nonprofits, but they're going to court with the HCA-owned ones. Meanwhile, they got in-network status with at least the Blues and UHC, which is good for me.
In researching this place (it's a freestanding doctor-owned specialty hospital--outpatient surgeries, overnight stays, and the like) I found that they have sued all the hospital systems in the region for conspiring to keep them out of preferred provider networks in a Sherman anti-trust action. They've settled with the nonprofits, but they're going to court with the HCA-owned ones. Meanwhile, they got in-network status with at least the Blues and UHC, which is good for me.
I only had c-spine, myself.
Hey, good news! I called the one freestanding MRI place that didn't only mention they had an open MRI. Turns out theirs is a large-bore closed MRI of 1.5 Tesla. When I told him I was looking for a 3T, he told me who to call! And I did, and the hospital is in-network, and I'm waiting for my neuro's scheduling person to call me back so we can set it up! This guy used to work at the hospital where I've been going and he says they're getting a 3T, but he doesn't know when it will be ready to go.
Man, there's some fascinating reading out there when you go around researching MRIs. There is an architecture firm that specializes in designing MRI suites safely and in training people about it. Complete with horror stories and driver's ed style film demos of what happens when things get sucked into the magnet. No wonder they wand you before they let you in the room. Not that I want to alarm anybody or anything. I just thought it was cool. You know, kind of like salad tongs through the head.
Holly
Hey, good news! I called the one freestanding MRI place that didn't only mention they had an open MRI. Turns out theirs is a large-bore closed MRI of 1.5 Tesla. When I told him I was looking for a 3T, he told me who to call! And I did, and the hospital is in-network, and I'm waiting for my neuro's scheduling person to call me back so we can set it up! This guy used to work at the hospital where I've been going and he says they're getting a 3T, but he doesn't know when it will be ready to go.
Man, there's some fascinating reading out there when you go around researching MRIs. There is an architecture firm that specializes in designing MRI suites safely and in training people about it. Complete with horror stories and driver's ed style film demos of what happens when things get sucked into the magnet. No wonder they wand you before they let you in the room. Not that I want to alarm anybody or anything. I just thought it was cool. You know, kind of like salad tongs through the head.
Holly
When speaking of spinal cord MRIs, which one? Cervical or thoracic?
I only had a cervical done.
Suzanne
I only had a cervical done.
Suzanne
Wow, interesting reading. I know my neurologist, Dr. M, feels that a 1.5T is quite sufficient for the brain. But, I have also read good studies that put the additional lesion pickup at 25% better than the 1.5T in back to back comparisons. So for twice the magnet strength you get a 25% improvement in lesion pick up.
I still feel deep down inside (though I respect Dr. M enormously, and he may well be right) that if your biggest problem is too few lesions, then the 3T is the only way to go. If it shows just one or two more, it may be enough to put you over. I had my most recent brain MRI done on a 3T and it was no different than the previous three I had had on a 1.5T machine.
So for diagnosis, if lesion number is one of the things holding you back, I would go for the 3T. For followup of disease, the brain done on a 1.5T is adequate.
The case is very different with spinal cord MRIs. Dr. M feels the 1.5T is worthless and will only schedule them (if possible) on the 3T. For me the 1.5 revealed no spinal lesions and the 3T showed 6!
That my input. Quix
I still feel deep down inside (though I respect Dr. M enormously, and he may well be right) that if your biggest problem is too few lesions, then the 3T is the only way to go. If it shows just one or two more, it may be enough to put you over. I had my most recent brain MRI done on a 3T and it was no different than the previous three I had had on a 1.5T machine.
So for diagnosis, if lesion number is one of the things holding you back, I would go for the 3T. For followup of disease, the brain done on a 1.5T is adequate.
The case is very different with spinal cord MRIs. Dr. M feels the 1.5T is worthless and will only schedule them (if possible) on the 3T. For me the 1.5 revealed no spinal lesions and the 3T showed 6!
That my input. Quix
IT WILL BE INTERESTING TO SEE WHAT THE MS CLINIC SAYS THIS WEEK ABOUT THE 1.5 TELSA. I AM NOT GOING TO BRING IT UP THOUGH.
THE EYE DOCTOR I SEE UP HERE TOLD ME NOT TO HAVE ANOTHER MRI DONE IN THIS AREA OF THE STATE BECAUSE THE BIGGER HOSPITALS AND DOCTORS DOWN STATE SAY THE ONES DONE UP HERE ARE WORTHLESS TO THEM.
BUT I HAD TO GET ANOTHER ONE DONE UP HERE BECAUSE THEY DID NOT WANT ME TO WAIT BECAUSE OF MY EYE. LITTLE GOOD IT DID THOUGH BECAUSE NO ONE WANTED TO DO ANYTHING ABOUT MY EYE. AT LEAST THE ON PAIN IS GONE.
I AM WONDERING IF INSURANCE WILL COVER ANOTHER BRAIN MRI THIS SOON IF IT IS ORDERED JUST BECAUSE OF MACHINE STRENGTH. WELL, TWO MORE DAYS AND I WILL GET AN ANSWER I GUESS, I HOPE!
LA
THE EYE DOCTOR I SEE UP HERE TOLD ME NOT TO HAVE ANOTHER MRI DONE IN THIS AREA OF THE STATE BECAUSE THE BIGGER HOSPITALS AND DOCTORS DOWN STATE SAY THE ONES DONE UP HERE ARE WORTHLESS TO THEM.
BUT I HAD TO GET ANOTHER ONE DONE UP HERE BECAUSE THEY DID NOT WANT ME TO WAIT BECAUSE OF MY EYE. LITTLE GOOD IT DID THOUGH BECAUSE NO ONE WANTED TO DO ANYTHING ABOUT MY EYE. AT LEAST THE ON PAIN IS GONE.
I AM WONDERING IF INSURANCE WILL COVER ANOTHER BRAIN MRI THIS SOON IF IT IS ORDERED JUST BECAUSE OF MACHINE STRENGTH. WELL, TWO MORE DAYS AND I WILL GET AN ANSWER I GUESS, I HOPE!
LA
SOUNDS LIKE THE 3T IS BETTER THAN THE 1.5? I HAVE BEEN IN THE 1.5 AND H AND A COUPLE OF THINGS SHOW UP.
DOES THAT MEAN I PROBABLY HAVE OTHER THINGS THAT ARE NOT SHOWING UP? BY THINGS I DO MEAN LESIONS.
LA
DOES THAT MEAN I PROBABLY HAVE OTHER THINGS THAT ARE NOT SHOWING UP? BY THINGS I DO MEAN LESIONS.
LA
Grrrrrr! That is just not right! And yet they get away with that. Do they ever 'reward' people for being healthy (not that they should)? Give premium payments back?
Grrrr!
Zilla*
Grrrr!
Zilla*
I had my 2 MRI's only 2 months apart and they were both prior-authorized. I am sure that the MRI's you have had were also prior-authorized. We got a LOT of apologies from the hospital billing people, & I don't think that this happens to most people. Even my neurologist seemed a little shocked. Another "great" thing about UHC is that I have been healthy for years hardly seeing a doctor, and since all this has happened... our office copays and rx copays have gone up (doubled) in the middle of the sign up year. They covered it up by saying it was open enrollment (again) after only 6 months.
We do MR imaging for breast implant ruptures, and UHC requires pre-approval for that, I know. With a different diagnosis code, it may be different. Your doc's office will know, but I would make sure before having it done. Good thinking!
Z*
Z*
Yeah, I have United too. The hospital in town with the 3T head-only is in-network, so anything they would bill that exceeds their UHC contracted rate would be written off. The lesser billings at freestanding facilities are because they're not bearing all of that awful hospital overhead, and of course, that's why the insurance would give you incentives to go to them first. Another question I'm going to have for them is whether the neuro needs pre-approval to do the repeat tests and and if they limit the interval between them.
I have run into this same problem. My first MRI was in a freestanding facility and my insurance paid 100%-It was a closed 1T. My neurologist didn't like their films (for some reason) and wanted me to have it done a the hospital the next time. Well, we have ended up owing @ $1500 from that one and I personally thought the FIRST films looked better! The hospital was an open 1.5T.
Anyway, we came to find out that the difference was how the 2 facilities BILLED the MRI. The freestanding one billed as an office visit and the hospital billed as an outpatient. (we have United Healthcare). Not to mention that the freestanding facility billed the insurance much less and I am sure that had something to do w/it.
I guess if I thought the second was 10 times better, I personally wouldn't mind paying the difference!! I am not sure how close you are to a diagnosis, but if I had access to a 3T, I would pay $1000 just to make sure that any WML's weren't being missed. (My issue is that I have numerous lesions, but not in the right place)
I would definitely take everything Heather said into consideration and ask your neurologist to clarify (the reason to repeat mri's) all of it and then weigh your Tesla options.
I had just called to cancel my scheduled MRI at the hospital for May, and I am trying to decide what to do also. Be sure and keep us updated!
Stacey
Anyway, we came to find out that the difference was how the 2 facilities BILLED the MRI. The freestanding one billed as an office visit and the hospital billed as an outpatient. (we have United Healthcare). Not to mention that the freestanding facility billed the insurance much less and I am sure that had something to do w/it.
I guess if I thought the second was 10 times better, I personally wouldn't mind paying the difference!! I am not sure how close you are to a diagnosis, but if I had access to a 3T, I would pay $1000 just to make sure that any WML's weren't being missed. (My issue is that I have numerous lesions, but not in the right place)
I would definitely take everything Heather said into consideration and ask your neurologist to clarify (the reason to repeat mri's) all of it and then weigh your Tesla options.
I had just called to cancel my scheduled MRI at the hospital for May, and I am trying to decide what to do also. Be sure and keep us updated!
Stacey
Hi, Heather. I can't show her definite relapses and remissions is the problem, but new lesions on MRI could be dissemination in time, and a stronger MRI should make my brain light up like a Christmas tree. Pretty normal physical exams, too--just my observations of symptoms like parasthesias and fatigue, but nothing she can objectively observe in her office. I'm pretty sure the purpose is to decide on treatment.
Cowgirl, very good idea about calling the manufacturers. I have been going about my online research backwards. The nearest place I have found is about 4 hours away that can do all the parts at once. It would be difficult to take a whole day off from my new job and I want to make a very good impression on them since it's seasonal--I want to be offered a permanent one or at least be called back next year. I don't think my doc has a stake in the machine--she's part of a large neuro practice that rents offices a block from the big hospital, and my PCP has ordered my tests so far at the smaller (affiliated) one near home.
Even if I go to a typical 1.5T machine, it'll still be 5 times stronger than the first one. Is that how the increases go, strictly linear? Or is is more like earthquakes and tornados, where a doubled number doesn't necessary mean a doubled strength? Quix, could you please weigh in on this?
H
Cowgirl, very good idea about calling the manufacturers. I have been going about my online research backwards. The nearest place I have found is about 4 hours away that can do all the parts at once. It would be difficult to take a whole day off from my new job and I want to make a very good impression on them since it's seasonal--I want to be offered a permanent one or at least be called back next year. I don't think my doc has a stake in the machine--she's part of a large neuro practice that rents offices a block from the big hospital, and my PCP has ordered my tests so far at the smaller (affiliated) one near home.
Even if I go to a typical 1.5T machine, it'll still be 5 times stronger than the first one. Is that how the increases go, strictly linear? Or is is more like earthquakes and tornados, where a doubled number doesn't necessary mean a doubled strength? Quix, could you please weigh in on this?
H
Hi, Holly~
If you haven't spoken to your insurance company yet, don't assume yet what your co-pay will be. If you've tried to calculate what you will owe, you must realize that you will only be responsible for a percentage of what's "allowable" by the insurance company, what they determine to be "reasonable and customary" for that region, NOT exactly what the MRI facility charges.
Sometimes what the insurance company deems reasonable and customary is a little less than HALF of what the actual charge is.So, then you would pay your percentage of that. (Took a course in medical billing and do a lot of the billing in the doc's office I work for.)
So, if you've not spoken to anyone yet, don't fret! Also~ you have the right to fight. If the better facility found the lesions (and I'm so sorry they did, Holly!) tell your insurance company they should be willing to pay for that at a higher percentage.
THere is a clause usually that states that uf there is not a physician in your insurance network that in a particular specialty, or if you do not have enough specialists to choose from in your area in-network, you may go outside the network. The same should apply for the machines, I should think. The lower magnets couldn't have picked up he lesions. The better machines aren't in your network. Not your problem. Fight it.
Good luck. And, again, sorry for your news, Holly.
Hope it helps. It's confusing, so I'm here if you have more questions.
Zilla*
If you haven't spoken to your insurance company yet, don't assume yet what your co-pay will be. If you've tried to calculate what you will owe, you must realize that you will only be responsible for a percentage of what's "allowable" by the insurance company, what they determine to be "reasonable and customary" for that region, NOT exactly what the MRI facility charges.
Sometimes what the insurance company deems reasonable and customary is a little less than HALF of what the actual charge is.So, then you would pay your percentage of that. (Took a course in medical billing and do a lot of the billing in the doc's office I work for.)
So, if you've not spoken to anyone yet, don't fret! Also~ you have the right to fight. If the better facility found the lesions (and I'm so sorry they did, Holly!) tell your insurance company they should be willing to pay for that at a higher percentage.
THere is a clause usually that states that uf there is not a physician in your insurance network that in a particular specialty, or if you do not have enough specialists to choose from in your area in-network, you may go outside the network. The same should apply for the machines, I should think. The lower magnets couldn't have picked up he lesions. The better machines aren't in your network. Not your problem. Fight it.
Good luck. And, again, sorry for your news, Holly.
Hope it helps. It's confusing, so I'm here if you have more questions.
Zilla*
I would get the 3T in one fell swoop on everything. When my symptoms started in Dec 07, I went from the eye doc in the mall, to an ophthalmologist, to a neuro, in one week. My neuro found 3 lesions on my brain and one on my Chiasm on HIS offices' MRI. I went to a Neuro Ophthalmologist at a huge teaching hospital (with my mri's from the neuro's machine) two weeks later and he said they were ****...couldn't tell what it was on my Chiasm...meanwhile, I can't see out of that eye to drive!!! After calling around my local area, I found one hospital with a T3 and I called my neuro and asked him to write a script for Brain, Orbits, Cervical with and without on a T3 (because of what the neuro-Ophthalmologist said). He was a little insulted that "His" machines weren't that good (come to find out they were T1.5 !!) and he admitted it, but I need a clear picture and I can't be ***** footing around with THEIR feelings when it's MY health and MY money. So.....I'm scheduled for Monday. If you didn't see my new post, I've only been doing this since December 07 and I'm freaking out. You have to be PROACTIVE and call "some" of the shots anyway. I say do some research and find a T3 machine and get it all done on the newest machine available. I've read that T3's pick up 25% more lesions in people with MS. Sorry to ramble, it just upsets me that these guys can call the shots when it's our health and well being that matters, not if they get to use THEIR machines and make the money. I'm sure they have a "mortgage" on that machine and need to keep it in use or upgrade it. I'm a business woman and think of all crazy stuff. If you can afford it, go for it. When I was calling around, I got a very knowledgeable MRI tech who explained all this T stuff to me and said I should go on-line and look up Siemens and Phillips and call them and ask where they have put any of the new T3 machines in my area.
I may be way off base here...but if you are looking for signs of MS through lesions, you have them in the right places, the brain AND the spinal cord. If you have an abnormal physical exam and can show definite relapses and remissions, than I think that it would be safe to say that these lesions are probably caused by MS.
Why do they want to repeat the MRI's in April? What are they looking for? More for a diagnosis? That's alot of money out of your pocket.
It's true the "open" MRI does not have great resolution, versus the closed MRI's. And yes, the more powerful the magnet, greater than 1.5t the better. I just had my recent MRI done with a 3T and it showed images that were so clear I could hardly believe my eyes. This is my first time in the more powerful 3T with a 7T on the horizon.
I believe that if any Neuro is smart, they know that there will always be lesions that cannot be seen, as Quix can attest too. If you already are showing lesions in the entire central nervous system, I don't think unless it's for purposes of deciding on trreatment, whether it would be worth the extra cost of having yet another set of MRI's in April.
Heather
Why do they want to repeat the MRI's in April? What are they looking for? More for a diagnosis? That's alot of money out of your pocket.
It's true the "open" MRI does not have great resolution, versus the closed MRI's. And yes, the more powerful the magnet, greater than 1.5t the better. I just had my recent MRI done with a 3T and it showed images that were so clear I could hardly believe my eyes. This is my first time in the more powerful 3T with a 7T on the horizon.
I believe that if any Neuro is smart, they know that there will always be lesions that cannot be seen, as Quix can attest too. If you already are showing lesions in the entire central nervous system, I don't think unless it's for purposes of deciding on trreatment, whether it would be worth the extra cost of having yet another set of MRI's in April.
Heather
Hi there. This is a complicated question that I can't presume to answer, but I do advise you to make sure about the strength of the magnets. I didn't know there were any at only 0.3 in use. That's hardly any. Now 3.0 is another thing entirely. So my first move would be to verify all this before considering these options.
ess
ess
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