1

Who is supposed to do the preauthorization for an MRI in the USA? Is it the responsibility of:

  • the physician who prescribed the MRI
  • the medical center where the MRI is performed
  • the patient, who should directly ask their insurance for a preauthorization

?

  • Who requested it? I'm assuming your carrier wants you to have MRIs preauthorized? And probably wanted you to have an X-ray first. – quid Jul 7 '17 at 5:31
  • @quid I like to ensure that the MRI is covered before doing it. – Franck Dernoncourt Jul 7 '17 at 13:35
  • @quid (4,000 USD was the price of my last MRI, at MGH, luckily covered) – Franck Dernoncourt Jul 7 '17 at 17:40
3

The medical center where the MRI is to be performed generally sends a request to the insurance company seeking pre-authorization for the procedure, and the insurance company might, or might not, contact the patient to let the patient know that pre-authorization has been requested, or to request clarification of some matter etc. Sometimes, the patient perforce has to call the insurance company to ask about a pending request "I am scheduled for gallbladder removal tomorrow but the pre-authorization has not come as yet" and on occasion the patient needs to call directly seeking pre-authorization, especially if the procedure is deemed to be elective and not strictly medically necessary, or if there is no evidence that other, less expensive or less invasive, treatments have been tried but have failed.

2

Generally the doctor/facility you're working with will request the preauthorization. In-Network providers are plugged in to the various insurer systems to determine whether or not a procedure:

  1. requires a preauth, and/or
  2. is a covered treatment for the indicated diagnosis

and will generally take care of it. Out-of-network providers are a whole different animal. If you're particularly concerned call your carrier and request the form.

There are some procedures that an insurer will not authorize unless a lesser procedure has been attempted with a poor result. For some diagnoses an MRI is a secondary step after a failed/inconclusive X-ray. Even in these cases, with adequate physicians notes and a valid concern many carriers will preauthorize an MRI without the X-ray (or whatever secondary procedure).

Ultimately, it's on the patient to button these issues up with their insurer though many providers in this day and age deal with it.

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