MRI question.

Discussion in 'Medical Topics' started by A Good Friend, Jun 18, 2019.

  1. Asking for a friend:

    A neurologist recommended 3 MRIs:
    Brain
    Upper spine
    Lower spine
    All with and without contrast dye.

    One imaging center wanted $1,200 each and didn't want to do all three at the same session. (Too long on the table and too much dye for the body to shed).

    The other imaging center (operated by the prescribing physician) wanted $450 each and had no problem doing all three at the same time.

    I have no idea if one or the other makes more sense (except that he'd rather pay $1,350 than $3,600, all else being equal).

    comments?
     
  2. I forgot to say that this friend has self-grounded himself pending a diagnosis.
     
  3. wilkersk

    wilkersk Cleared for Takeoff

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    See if you can talk to a radiologist at the "prescribing physician's" facility (or the one he wants to refer you to) and see if they can tell you why they can do it all at once, and the other place doesn't want to. Could be a difference in the protocol and type of MRI equipment they have. That being said, I wouldn't want to do 6 different scans, all in one day, 3 with contrast, in the 15 year old 1.5T magnet my employer just got rid of.
     
  4. denverpilot

    denverpilot Taxi to Parking

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    Having just been through all of that, the following comes to mind:

    Many places won’t do multiple in one session not only because of the large amount of metal dye they’ll be injecting but because they want to bill it as three separate visits and make more money. Sad, but true.

    The other advice given is solid. Ask how they’ll go about it. Three in a row without and with contrast is going to be a marathon if your friend is at all uncomfortable lying still for a couple of hours, and up to three for that much imaging. I’d want a break from the noisy tube after two of those. The more he can hold still the sooner it’s all over. They usually ask you to hydrate well to get the IV needle in too, so a bio-break might be nice. Ha.

    Make sure the imagery can be done as ordered. There’s different strength magnets and some docs may be asking for 3T vs 1.5T. It enhances the images but makes them more susceptible to noise and movement of the patient. Usually only needed further along in a diagnosis for specific things but make sure he knows what’s being ordered to compare apples to apples. Vast majority are going to be 1.5T.

    Best resource your friend has probably forgotten is the customer service center of his own insurance company. Mine immediately told me that a particular imagery center in my State has a very solid contracted rate with them and it’s lower even than going to an in-network facility. Something I would never have known if I didn’t call. They’re a chain of imagery centers.

    The reason it’s so low is they don’t screw around with separate charges for the imagery, facility, and doctor’s analysis. All they do is imagery as a business and they learned quickly that insurers love them if they single bill always and also have a boatload of facilities all over the state to get people in out and done often in two days.

    Total cost to patient, $100 co-pay per visit even if multiple images ordered and the amounts they bill to insurance are reasonable also, looking at the EOBs. The insurers save thousands, sometimes thousands per image set depending on what’s being done.

    So tell him to check with the insurer, for sure.

    There’s not much difference between the imagery labs and the doc’s opinion at the lab usually isn’t too heavily weighted by the doc who ordered the imagery anyway. They want to look at it themselves or they wouldn’t have ordered it. Docs often have in-house imagery because they get a tiny bit bigger slice of the pie that way, and have a big loan on that big machine. If the insurer doesn’t care, then it becomes conveniences. If they do care, drive a mile and save hundreds. Even a thousand on that much imagery. Sorry Doc. Insurance company says they like this one. They understand.

    Also if he’s a pilot, have him just ask for at least two copies of the imagery on the way out the door. Takes most places about ten to fifteen minutes to burn a couple of CDs or DVDs and he will need them anyway for the FAA in the future more than likely. If not they’re easy to toss. But easier to get them then than later.

    He won’t be able to get the Doc’s report until later but make sure he collects that and sticks it in the future FAA pile also. Some of these places delete imagery after six months and then you’re screwed. Get copies. For the doc report ask how to get those copies also. The front desk will usually send however many copies you want to a paper mail address. It’ll save a little time ordering them from the records dept later.

    If he’s good at sleeping in noisy places, tell him to have them not pipe in music in the headphones. Many people report having a nice nap. I can’t sleep with all the noise so it’s classic rock for me. The different lab’s interpretations of “classic rock” are often part of the entertainment.

    Good luck to your friend. Here’s hoping he’s not among the 4% who are instantly nauseous from MRI contrast. It was a little touch and go there as to whether I was going to hurl on the half million dollar machine for a minute or so. LOL. Didn’t squeeze the ejection handle and it settles down in a couple of minutes. Moderate turbulence in the tummy for about two minutes.
     
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  5. weilke

    weilke Touchdown! Greaser! PoA Supporter

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    As for the prices:
    - You are watching the free market at work (just for comic relief, ask a hospital for a third quote).
    - You get what you pay for.

    Both are somewhat correct. 3 studies in one session can negatively affect quality as the patients tend to get restless after a while. But that's an individual thing, some can spend hours in the scanner and not move. Newer scanners and high field scanners (some of them employing higher magnetic field strengths at 3Tesla) can run faster sequences and there is no time or quality issue doing three in a session.

    (if insurance or medicare was involved, cynical me would suggest that someone is trying to get around the multiple procedure payment reductions for diagnostic services, but this seems to be a cash deal so it doesn't matter)
     
  6. PaulS

    PaulS Final Approach

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    Hey, Nate's back, welcome.
     
  7. WannFly

    WannFly En-Route

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  8. PeterNSteinmetz

    PeterNSteinmetz Line Up and Wait

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    I don’t know what the underlying issue is, but that is a lot of imaging and contrast. There are some conditions that might merit this, but I also would have to wonder about the history taking and diagnostic process being used here. If paying $3600 cash, I might consider seeing another neurologist to check if they concur this is needed.
     
  9. benyflyguy

    benyflyguy Pattern Altitude

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    Looking for Multiple sclerosis would be the only reason you’d be Doing MRI with/without from stem to stern. Can do together. MRI contrast is pretty safe. I don’t think Medicare bundles payments for multiple imagining like they do for medical/surgical procedures. Some places don’t want to tie up their machine for 3 straight hours on one person.
     
  10. Let'sgoflying!

    Let'sgoflying! Touchdown! Greaser! PoA Supporter

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    Hope you are ok, Nate.
    (and the OP)
     
  11. azure

    azure Final Approach

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    Good summary, my only comment is regarding the above... whether they will bill it as one if done all at the same time depends on the facility. I had a double once, two MRIs done at the same time, and it was definitely billed as two separate MRIs. It was done at a major hospital and the total charge was $4500 per MRI. That's not counting radiologist's fees. I ended up paying $2K out of pocket. :(

    Now, if I ever need an MRI I am going with a private imagery center. Here in NE we have OpenMRI - OP's region may have something similar.
     
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  12. Velocity173

    Velocity173 Touchdown! Greaser! PoA Supporter

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    Hey Azure is back!
     
  13. azure

    azure Final Approach

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    So's Nate! :)

    Me, I've just been very busy with a paper. Haven't been very active anywhere online. That's not likely to change for a while, I'm just taking a break today.
     
  14. Velocity173

    Velocity173 Touchdown! Greaser! PoA Supporter

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    I thought once you become a professor you’re done writing papers?
     
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  15. azure

    azure Final Approach

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  16. Doggtyred

    Doggtyred En-Route

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    Doing the 6 scans (3 without and 3 with gadolinium) the big issue is table time.. Not so much the contrast. They can do the brain, T spine and L spine without, then inject and do the 3 studies all over again for with.. one dose of contrast. Bam. Done. It lasts for a while.

    Time is the problem. especially with older machines. MRI involves putting you in a magnetic field, then hammering you with radio waves to energize your water molecules. This causes heating to you.. akin to a microwave. Not enough to cook/hurt, but if they do too much too fast you get warm and sweaty and uncomfortable. So there have to be pauses built into the scanning sequence. But you are laying there not moving.. MRI tables are not known for comfort. This takes time.

    Next thing.. is while there is a big antenna in the "donut" that transmits the radio waves, to be able to really "read" the energy coming back off the body there has to be an antenna (or coil, in parlance) really really close to the body. So MRI of the brain they put a cage like coil around the head. MRI of the spine they have you lay on a mat with the coil built in that puts it right up against the area being imaged. Most of the time only one of these coils can be in play at one time (the head, or the brain, or a leg coil for instance and the table is set up differently for each one.. so.. pull you out, get you off the sled, reconfigure, put you back in, scan the other area.. etc..

    So this comes down to the last factor. Laying on these tables isn't painful but its not comfortable. Most of us can emotionally power through a 30 minute scan but might have issues enduring 2-3 hours if needed for all the sequences on an older machine. A lot of folks are claustrophobic, and need something to "calm" them.. sedatives add a whole nother level of complexity to scanning... especially for long series of scans.. An oral versed might do fine for 30 mins or being stuffed in the magnet bore and staying still. But repeat dosing might be needed for complex series of scans. which means pulling out, giving more meds... sometimes it works, sometimes it doesn't.

    So these private, for profit imaging centers have found that they make more money, have less delays and "lost" time if they dont subject their paying customers to hours of scans in one session. You might be a trooper and do just fine.. or you might be the one that cant hang.. and now they have you "done" after 30 minutes with the machine scheduled for 3 hours and nobody else lined up. You will be the one spending an hour or two on the MRI table, the question really is.. one long session or several short ones on different days.

    If you find someplace that will do it all at once, be honest with yourself. You need to be NOT claustrophobic. With the medical equivalent of a football helmet/internal pads on your face. You need the discipline to lay perfectly still (and not fidget/squirm) for over an hour. You only end up getting one dose of contrast on one day and you get it all done.
     
  17. flyingron

    flyingron Touchdown! Greaser!

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    I agree with Doggy. My scan only runs about 48 minutes and I can't imagine doing it for 3 hours. I always find the process amusing because decades before I had my first MRI, I wrote some of the analysis software (I think I may have had the first non-vendor specific DICOM processing software we did under contract for the NIH). The stuff we did as pioneering back then they throw on the CDROM with your scan for free so your regular providers (the Radiologists probably have better software).