how to get an MRI approved by insurance 1

How To Get An MRI Approved By Insurance

An MRI, short for magnetic resonance imaging, uses magnetic fields to give medical professionals highly detailed images of a patient’s inner body that help them to diagnose injuries and illnesses. Your doctor may prescribe an MRI if they need to scan your joints, blood vessels, heart, and other internal structures. The results of a 3-D MRI scan can be used to help diagnose conditions, create treatment plans and determine the effectiveness of prior treatments. The catch is the scans are typically quite expensive, so getting coverage confirmation from your healthcare insurer is key.

How much does an MRI cost?

A typical MRI scan costs $2,600. That fee can go up or down significantly, depending on what type of facility conducts the scan, the geographic location, and the comprehensiveness of the scan. How widely can prices range? They can be $400 on the low end and as stratospherically high as $13,000. To get your insurance to cover the cost of your MRI, you must first determine if they will cover your MRI at all.

How to get prior authorization

Insurance companies often will agree to cover MRIs if patients obtain pre-approval for the imaging. This process, called prior authorization, entails giving the insurer additional information about why the doctor has prescribed the scan and what circumstances, such as an injury, led to the order. It is critical to fill out all pre-authorization forms completely and accurately. It is not uncommon for a scan coverage request to be delayed—or even denied—because of missing information or a minor mistake on the form.

For MRIs and PET scans, the insurance company commonly designates a third-party vendor to work with doctors on pre-authorization requests and determine whether the scan is needed or if alternative paths should be explored. But you should stay as closely involved with the process as possible because if the doctor fails to submit the requested information to the insurer or its designated benefits management company, you could end up on the hook for full payment.

A huge part of obtaining prior authorization is making sure that where you get your imaging is in-network

What if you’re denied prior authorization?

Patients whose scan coverage request is denied have the right to an explanation from the insurer. Your doctor’s office may be able to help you understand the stated reasons for the denial, but your best bet may be to directly ask the insurer or benefits management firm for the reasons why. If the explanation is confusing, ask them to repeat it in layperson’s terms. Getting past the technical terminology is critical because pre-authorization claims are often denied based on form submission mistakes and other issues that are simple to address.

The appeal process can be time-consuming, but there are ways to speed it up. The best way to do that is to ask your doctor to request a peer review of the request rather than going through more paperwork exchanges with the benefits company. Peer review means the physician can consult via the phone with another doctor who can quickly affirm the need for the scan once it’s properly explained. That’s why it’s so important to communicate directly with your medical provider in addition to the insurer when appealing a pre-authorization request for an MRI.

After your MRI has been approved by your insurance provider, you should contact your doctor’s office and the imaging center to confirm your appointment. Scheduling the MRI appointment may present its own set of challenges. 

To book a scan, visit us at Medmo.com. Medmo helps people schedule radiology imaging tests – such as MRI, CT scans, PET, and more – at nearby accredited centers and identify the payment solution that works best for them.

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