Many of our patients use medical insurance to cover the cost of medical procedures. It is important for you to understand and be familiar with your medical coverage when scheduling exams.
When your referring provider recommends that you have an imaging procedure, your provider will do one of the following:
- Provide you with a physical referral order and ask you to contact ARA to schedule your exam
- Electronically send your order to ARA and our schedulers will contact you to schedule your appointment
Once ARA receives your order for imaging services, we will work with your insurance company to obtain pre-authorization for your exam.
Here are the answers to many questions about obtaining insurance authorizations:
Pre-authorization is the process of getting the prior approval/notification for an imaging exam from your designated insurance provider to ensure your medical coverage for the exam.
A referral order is issued by your physician for you to obtain medical services from another medical provider to further your diagnosis or treatment. A pre-authorization is issued by the insurance company, giving ARA the approval or go-ahead to perform the necessary service under the insurance plan.
Who obtains pre-authorization?
With most plans, ARA will obtain the pre-authorization for your procedure once we receive an order from your medical provider. Select insurance companies, however, require the ordering medical physician to directly obtain the pre-authorization of the procedure due to plan restrictions.
The time to obtain pre-authorization varies by insurance plan. On average, pre-authorization can take three or four days to obtain, so it’s important for ARA to have all the necessary supporting documentation on file before submitting an authorization request on your behalf to your insurance company. In some situations, supplementary clinical information may be needed or the request needs to be reviewed, additional days may be needed for insurance company to make a final determination.
Most authorizations are only valid for 30 days but it varies by insurance plan.
If you receive a denial for an exam, ARA’s authorization team will work closely with your physician and insurance carrier to resolve the denial if possible. You may also contact your referring physician or insurance group for additional information regarding the appeal process. If you would like to proceed without insurance authorization, you can choose to pay for the exam at our existing out-of-pocket rates. ARA will no longer pursue authorization and you will be required to sign a waiver indicating your understanding that the exam will not be filed with your insurance.
Most insurance plans will ask for pre-authorization for high tech imaging exams like CT, MRI, nuclear medicine, and PET. The list of which exams require pre-approval will vary, depending on your insurance company and your plan, so we encourage you double-check everything beyond routine care ahead of your scheduled visit.
No. There is a difference between “authorization” and “coverage.” An authorization is a decision by your health plan that prior approval is required for certain services before you receive them. It’s not a promise that your health plan will cover the cost. It is important that you contact your insurance group or your referring physician to determine that the health care service that is being requested meets the medical requirements based on your personal coverage from your medical benefit plan.
Subject to state regulations, receipt of a notification or prior authorization number does not guarantee or authorize payment. Payment for covered services is contingent upon various factors including coverage within the member’s benefit plan.