As always, it’s never an easy question to answer; most imaging centers will accept your insurance especially if it’s an in-network facility. However, whether or not your insurance company approves (authorizes) your test can influence your out of pocket costs as well.
Insurance companies reserve the right to decide whether or not a procedure such as an MRI is medically necessary. Most companies require that CT and MRI requests be subject to a “medical necessity review”. The purpose of this review is to determine whether a particular diagnostic test or treatment is appropriate and essential. Decisions are made based on the standard of care and the individual health plan’s policies and clinical guidelines. For example, if an MRI is prescribed for cosmetic surgery, or to strengthen a worker’s compensation case, it isn’t medically necessary and will therefore not be covered. The safest (but not always the easiest) way to see if your test will be covered, is to call your insurance company and ask.
If your insurance doesn’t cover your test or if you don’t have coverage in general, getting the best out-of-pocket price for an MRI isn’t always easy.
In general, medical imaging is not cheap. According to Forbes, an MRI scan can cost between $500 and $3,000. Most MRIs are typically covered by health insurance when deemed medically necessary but patients often have to meet their deductible before insurance kicks in (which means you might cover the cost of your test and at a higher insurance negotiated price).
A deductible is the amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services. Many people find it difficult to meet their deductible and even when they do, they may be faced with more out-of-pocket expenses and wait-times.
Medmo connects patients with medical imaging prices they can afford, guaranteeing patients will receive the most convenient and affordable services at quality centers, as well as lowering their out-of-pocket costs, even with insurance.
A study found that patients who know how much a medical procedure will cost will save money on healthcare overall—presumably because they choose the lower-priced practitioner. The National Bureau of Economic Research found: “Despite significant out-of-pocket cost exposure, patients often received care in high-priced locations when lower-priced options were available. Fewer than 1 percent of individuals used a price transparency tool to search for the price of their services in advance of care.” With Medmo, it’s even easier to compare prices. Instead of guessing the bill (and praying there isn’t a huge surprise), or spending time cross-checking centers with insurance and availability, patients can just tell us the price you can afford. We will even tell you whether there are cheaper payment options outside of your insurance.
Many people find themselves looking for other ways to lower their MRI costs. There are situations where it’s more financially sound to pay in cash, rather than deal with any insurance. To find out if your MRI is covered by insurance or if there’s a cheaper option, click here.