Is it possible to get an MRI and have it read, without a referral?

July 18, 2008 4:13 PM

Is it possible to get an MRI and have it read, without a referral?

Long story short: I was referred to a neurologist. The neurologist pressured me to get a CAT scan and a spinal tap to rule out a certain condition. I do not want to do this; I want an MRI instead. The condition we're talking about can be diagnosed equally effectively using an MRI.

A second neurologist also insists on the CAT scan/spinal tap combination. (They're both affiliated with the same hospital).

I want an MRI to rule out this one, specific condition.

Is it possible for me to get an MRI on my own and have it read, without going through these neurologists?

I live in New Jersey.

posted by anonymous to health & fitness (12 comments total)

Paying out-of-pocket, or through insurance?
posted by Civil_Disobedient at 4:30 PM on July 18, 2008

you may be able to, but i doubt your insurance would cover it. have you talked to your neurologist about why they prefer the CAT/tap option and asked them if you can do an MRI instead?
posted by thinkingwoman at 4:31 PM on July 18, 2008

Yes, it's possible. It's very expensive, and a lot of radiologists won't even consider trying to interpret such a study without a referring doctor's request, because of the malpractice liability. (You cannot have the test performed without paying for its interpretation, as far as I am aware.)

It can cost anywhere from $1500 to $3500. Your insurance will never reimburse you for this because no physician has requested it.

This is probably a side note and likely unwanted information, but I think it's necessary: if the docs think you might have subarachnoid hemorrhage, you're wrong. MRI is not as sensitive as CT/LP. It's easy to miss SAH on the MRI. On the upside, the LP only needs to be done if the CT is negative. I'm pretty sure that SAH is what these docs are worried about because it's one of the few conditions where a CT is preferable to an MRI, and it's the only condition I can think of where the CT is usually followed by an LP.

In this setting ordering the CT is not about cutting costs; it's about ordering the most appropriate test for the condition. The false negative rate of CT is about 10% in SAH; the false negative rate of MRI is considerably higher, enough that we don't use it. The false negative rate of LP after CT is less than 1 percent (depending on how much time has elapsed).
posted by ikkyu2 at 4:36 PM on July 18, 2008 [8 favorites]

Are you just afraid of the spinal tap?
posted by kldickson at 5:05 PM on July 18, 2008

Honestly, I would trust the doctors' opinions. They didn't go to medical school for nothing. I've been around doctors long enough to know how annoying it gets when patients don't listen to them.

I don't know what condition you're trying to r/o, but if you really think an MRI is necessary, try to find a doctor that will think the same and refer you to get an MRI. If you're just trying to avoid the lumbar puncture - it's really just not worth it.
posted by ssnickerer at 5:56 PM on July 18, 2008

Oh also - if you're afraid of the radiation from a CT, it's really not worth it either, provided that it's the best route of diagnosis (which, from the two doctors' opinions, does seem the case). Each one of us has roughly a 20% chance of developing some type of cancer (or something like that). One full abdominal CT (from the nipples to the pelvis) adds about another 0.25% chance to that risk, which is pretty darn marginal. I don't know what part of the body needs to be examined, but I'm sure the numbers are similar elsewhere in the body.
posted by ssnickerer at 6:02 PM on July 18, 2008

It is possible - I have done it myself (Maryland) - it will be an out-of-pocket expense, most likely (mine was @ $1300).
posted by ersatzkat at 6:34 PM on July 18, 2008

ersatzkat: You just contacted the imaging place and asked how much for an MRI without a doctor's referral? I didn't think medical places would do that without a referral for liability reasons, as ikkyu2 mentions.

note: I'm not the OP
posted by Justinian at 7:25 PM on July 18, 2008

"The condition we're talking about can be diagnosed equally effectively using an MRI."

How do you know this? They might be recommending this because the CT/LP route is much cheaper than an MRI. If you don't need a $1500 MRI, why bother getting one when a $300 CT and a $100 LP will work just as well?
posted by ruwan at 9:01 PM on July 18, 2008

Some MRI studies will provide you with structural MRI images if you do their study. They definitely won't interpret it, and there's a good chance the MRI they'll do will be absolutely useless for your condition, but you can look around at neuro labs in your area. I'd strongly consider getting over whatever fear you have of a CT & spinal tap. The alternative may start you down a rougher (and ineffectual) road.
posted by devilsbrigade at 1:58 AM on July 19, 2008

Justinian - yes. I had to sign a LOT of forms.
posted by ersatzkat at 4:40 AM on July 19, 2008

Probably.

This site mentions MRI scans, and purports to have a database of places where you can get scans done. You might check the surrounding states if none of the facilities in NJ do MRIs. http://www.bodyscan.md/ I don´t claim to know if this site is even a reliable source of information, but it will probably at least give you some numbers to call.

If your unspoken question is will my insurance pay for this without a referral, the answer to that is no, of course your insurance will never pay extra for a test your doctor says you do not need.
posted by yohko at 9:37 PM on July 20, 2008