Health Organization for Pudendal Education

Question re Dr Potter...Can anyone tell me how much Dr Potter's MRI costs. Total including any fees the hospital bills and Dr Potters fees. I have insurance, but am not sure how much if any they will cover. I want to be prepared for the total cost, in case I have to pay. And then appeal my insurance decision. Thanks.

About $3000.

Thanks for the info.

donstore wrote:About $3000.

Don,

Was this before or after insurance? HSS is in-network on my insurance, but Dr. Potter is not. What were her fees to read the MRI, do you remember?

I'm scheduled for May, but trying to decide if it's really worth it. Not sure I'm going to have surgery anyways.

You getting geared up for your Hibner appointment? I hope it goes well! Keep us updated.

Good question Faith. I just checked my insurance and my coverage is the same as yours.

Faith wrote: HSS is in-network on my insurance, but Dr. Potter is not.

At the time I went to NY, I had BC/BS PPO. My referral was for a 3T MRI - not a visit with Dr. Potter. So, like you - HSS was covered in-network by my insurance but not Dr. Potter.
The MRI was covered 100%.

I had Healthnet HMO and they paid $360 (their in-network contract rate for a pelvic MRI) which left me with just under $2000 to pay HSS out-of-pocket. I also had to pay Dr. Potter's reading fee which was $450. I had a 1.5T MRI due to my metal hip (Dr. Potter said the 3T would produce too many artifacts). She was in the room with the tech while the images came in because they did another pass at an area she found to be particularly suspicious. She met with me after and we discussed the images. The 3T might cost more. I'm sure someone at HSS could give you that info. I would definitely try to sort this out with your insurance beforehand.

Faith - Thanks for your good wishes as my big day approaches. I hope you are finding some relief as you search for answers before pulling the trigger on surgery. I am also not sure about surgery as well since 600 mg. of Lyrica and 30-40 mg. of oxycodone per day have allowed me to keep working. I would still like to seee what Dr. Hibner has to say and to be further along in the process if things get worse.

Don

Hi ALL,
Does anyone know about the procedure code for Potter's MRI? I learned from my insurance that neither Potter nor the hospital are in my network and thus my insurance will only cover 50% of the allowable rate. This is very discouraging. I have to fly out from the West Cost. With the traveling cost and out of pocket cost, i am not sure whether or not i can afford it.

I have BS of California.

HSS charged $2364.00. My out of pocket was $207.00. Code: 72195

Dr Potter charged $458. My out of Pocket was $11.41.

Maybe you could consider having the MRN if you live in California and if your insurance would cover it.

Violet