How To Get An MRI Approved By Insurance

How To Get An MRI Approved By Insurance

If you suffer an accidental injury, your doctor may order an MRI to examine your joints, tissues, or organs. An MRI or magnetic resonance imaging is a painless way for doctors to see inside the body to help them diagnose problems. Unlike an X-ray, which is basically a snapshot, an MRI scanner uses magnets and radio waves to give doctors a detailed cross section of various parts of the body including organs. These scanners can also produce 3-D images of the body’s systems, which can help doctors make more precise diagnoses and see potentially serious problems so that they can be treated before they become a serious medical crisis. Although they are considered standard diagnostic tools, the cost of having one can be significant, especially if your insurance doesn’t cover it.

How much does an MRI cost?

A typical MRI scan costs $2,600. But that bill can balloon up depending on where you get your scan done, location, and the type of scan you need. Some facilities might charge as little as $400 or up to $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

Talk to the Decision-Making Person

While it’s your health insurance company that requires prior authorization, also known as pre-authorization, it’s not necessarily your health insurance company that makes the decision about whether your prior authorization request is approved or denied. Although a few health plans still do prior authorizations in-house, many contract these tasks out to benefit management companies.

How to Get Prior Authorization

Prior authorization is often required by insurance companies for services such as MRI’s, other scans. When a prior authorization is requested it means that the insurance carrier needs more information before making a final decision on whether it will be covered. When you submit a prior authorization request, make sure the information you submit is totally accurate and is thorough. Prior authorization requests can be denied or delayed because of seemingly mundane mistakes.

For MRIs and PET scans, the insurance company will often have a third party vendor that your doctor will have to work with to ensure that the scan is necessary and the best course of action at the time. It will be the responsibility of your doctor to obtain a prior authorization; however, if your doctor does not provide the information requested by the insurance company, you may become responsible for the entire cost of the scan.

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?

If your request for prior authorization has been denied, you have the right to know why. You can ask your healthcare provider’s office, but you might get more detailed information by asking the medical management company that denied the request in the first place. If you don’t understand the jargon they’re using, say so and ask them to explain, in plain English, why the request wasn’t approved. Frequently, the reason for the denial is something you can fix.

If you are denied by your insurance company, your doctor’s office will receive a fax with the reason the claim was denied and the information that will be needed in order for it to be reconsidered. You will also receive a letter in the mail making you aware. To help speed up the process by minimizing the back-and-forth between your insurance carrier and your doctor’s office, your physician should request a peer-to-peer review versus the standard paperwork. This is because it provides an over the phone meeting with a medical professional.  It is important to realize that your doctor’s office plays a significant role in whether or not the prior authorization is accepted, not just the insurance company. You should also contact your doctor’s office directly to stay informed on the process, especially if the scan you need is time sensitive.

After your MRI has been approved by your insurance, 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 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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