Health Organization for Pudendal Education

Just had my follow up appointment with Dr. Gordon yesterday, I asked if we would support me in trying to get OHIP to cover the cost of an MRI with Dr. Potter and he said he would. He is asking me to provide him with information on how Dr. Potter’s MRI differs then what we have here in Canada. I believe it has to do with the software she is using? Can anyone confirm what is different or know if Dr. Potter can provide me with this information?

Also, does anyone know if I can pay for the test out of pocket and then file a claim with OHIP after the fact? TIA

Paulsa,

That's great about Dr. Gordon's support! You can find alot of information on this forum about Potter's MRI by using the search function above. As for OHIP (Ontario Health Insurance Plan) procedures, Pelvis Stressly might be able to help you. As far as I know, the three of us are the only Canadians here.

PaulSa wrote:He is asking me to provide him with information on how Dr. Potter’s MRI differs then what we have here in Canada.

Read Hilary's posts in the following 2 threads PaulSa (she knows a lot about the technical side of imaging, and discusses what differentiates Potter from other radiologists)... http://www.pudendalhope.info/forum/view ... 301&p=2101 and, http://www.pudendalhope.info/forum/view ... t=67&p=551

PaulSa wrote:Also, does anyone know if I can pay for the test out of pocket and then file a claim with OHIP after the fact?

No...they won't reimburse anything retroactively (ie. you need approval first).

Lernica wrote:As far as I know, the three of us are the only Canadians here.

'sgrandy' (or Stephanie) is also from somewhere in Ontario.

Pelvis Stressly wrote:

PaulSa wrote:He is asking me to provide him with information on how Dr. Potter’s MRI differs then what we have here in Canada.

Read Hilary's posts in the following 2 threads PaulSa (she knows a lot about the technical side of imaging, and discusses what differentiates Potter from other radiologists)... http://www.pudendalhope.info/forum/view ... 301&p=2101 and, http://www.pudendalhope.info/forum/view ... t=67&p=551

PaulSa wrote:Also, does anyone know if I can pay for the test out of pocket and then file a claim with OHIP after the fact?

No...they won't reimburse anything retroactively (ie. you need approval first).

Lernica wrote:As far as I know, the three of us are the only Canadians here.

'sgrandy' (or Stephanie) is also from somewhere in Ontario.

Thank you very much!

No prob.
Hope you have better luck than I did in convincing OHIP to pay for Potter's services!

PS,

Did you do a Potter MRI? What did it end up costing you?

PS is right...I'm also a Canadian from Ontario I will be seeing Dr. Gordon later this year as he is really the only knowledgable neurologist in Canada with regards to any kind of pelvic pain. Granted, I'm doing a heck of a lot better than I was in December of last year (as in 95% better) but I relapse and remit constantly and have over the past 6 years I have had this problem. We still aren't sure exactly what the problem is...could be autoimmune but we also know that there are alignment and muscular issues as well. I will most likely go to NYC to have the MRI by Dr. Potter at some point in the future so it will be interesting to see if OHIP will fund it especially since my husband and I were going to have to come up with the money which is hard when you have a new house to pay for! (in case anyone is curious...yes, I am fully capable to work full-time and sitting the majority of it as well).

Stephanie

Ok, here's a little update. I spoke with Nina from Dr. Potter's office and she said she will speak with Dr. Potter today about the differences in the MRI she is using at HSS and what we use here in Canada. My wife (Partner in crime, she works in HR and gets stuff done ) has been in touch with Dr. Gordon’s contact at OHIP to try and fast track this if possible. She said that Dr. Gordon is highly respected and that what he writes on paper holds a lot of weight, so I guess we will see.

Thanks for the update Paul and please keep us posted!

Lernica wrote:Did you do a Potter MRI? What did it end up costing you?

Yeah, I was actually the one who found Potter & first went to her (well, in this current 'wave' of patients anyway...I found out about her by stumbling on a 2004 post on the old board by a guy who went by 'northernspy' who had been to see her), well over a year ago now.

After being denied by OHIP, I had what she called a "limited scan", which she felt would be sufficient (and 1/2 the price of a full pelvis MRI...came out to roughly $1500 US vs. $3000ish). That said, not sure if the limited scan (lasts about 30 min.) will really give them enough time to investigate the entire course of the nerve. For me it wasn't a concern though, as I knew my issues were at the level of the Alcock's Canal/dorsal branch/perineum, so wasn't too worried about what was going on higher up (at the level of the ligaments).

PaulSa wrote:I spoke with Nina from Dr. Potter's office and she said she will speak with Dr. Potter today about the differences in the MRI she is using at HSS and what we use here in Canada.

Just found an old e-mail to Nina where I asked her the exact same question PaulSa. Here's her response...

"At HSS our scans are performed with very high in plane and through plane resolution which affords direct visualization of the nerve and there is differential contrast that accentuates foci of the perineural scarring or frank neuroma formation."

Maybe that'll help. And again, hopefully OHIP has caught wind by now of how many people are seeing Potter for this purpose & you'll have better luck than I did convincing them to foot the bill!
Good luck, PS