HomeHealth InsuranceWill Your CT or MRI Scan be Denied?

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Will Your CT or MRI Scan be Denied? — 14 Comments

  1. I am going through this right now. My CT scan was scheduled for tomorrow at a hospital and my insurance company did not authorize so the hospital cancelled my appointment. Doctor’s office talked with the insurance company and provided them with whatever they asked for. I have to wait till Monday to find out whether or not they will authorize. And if not I will have to get x-ray or ultrasound done.

    • I am so sorry. Hopefully, they will approve the request now that they have additional information from your doctor. Ultimately, they may approve the test but they may require that you have it done at an outpatient facility instead of a hospital. The cost difference can be huge!

  2. And if they see something in those tests, the insurance company will have the evidence that a CT scan is needed. So I have waited over a month now already and maybe I will have to wait another month or longer just to find out whether or not I have cancer. That is so messed up. Why are they asking for evidence for the need of this test? The test is to find out what is wrong. How can anyone know what is wrong without the test result? I have low wbc (it was Normal in January) and I have 7-8 swollen lymph nodes in my neck for over 5 weeks now. Isn’t that enough reason for a concern? I am so stressed already and the insurance company is making is worse.

    • Oh my goodness, I’m sure this is very stressful for you. Please be diligent about following up with the request. Unfortunately, there is often a disconnect between patient care and the insurance companies who pay for it. I wish you the best of luck.

      • Thank you! There is a 90% chance that I do not have cancer. I am trying to think positive. It’s just that I was so close to finding out and the process delayed last minute. My doctor and his staff are very helpful so I am sure it will work out eventually. Hoping for the best.

  3. I’m running into issues with this as we speak. Anthem BCBS apparently uses a secondary company to determine whether a CT scan is needed. I have a softball-sized mass in my abdomen that was identified in an x-ray, after I complained about consistent abdominal discomfort that’s been going on for months. This company determined that a CT scan was NOT NECESSARY. My doctor now needs to contact the company to have a peer-to-peer review with their doctor about why it’s necessary for me to have this scan. If I hadn’t just spent the last week not sleeping while worrying about this, I’d laugh.

    I would never, EVER use this insurance company by choice.

    • Heather, I am so sorry to hear this. It is very frustrating when insurance companies get in the way of appropriate medical care. I’m sure your doctor will advocate for you during the peer-to-peer review. I wish you the best of luck and I hope you get a speedy resolution to your problem. Thank you very much for reading and sharing your thoughts.

  4. Denied ? $1700 a month that’s hardly used . One of these days everyone is going on strike ! They make a fortune! All about $$&& I bet no one in there family gets denied . They should trust the Dr. they need to be sued by anyone that dies because of being denied. Life is hard enough bring in pain and being denied of a test because of $ is a crime ! KARMA

    • Yes my wife died waiting for pet scan after haveing CT scan. Because insurance denied..they saw spots on lungs ended up in er said pneumonia turned to sepsis then septic shock she died 11/24/17 she had been seeing a lung specialist but was waiting on insurance to allow pet scan

  5. Yes my wife died waiting for pet scan after haveing CT scan. Because insurance denied..they saw spots on lungs ended up in er said pneumonia turned to sepsis then septic shock she died 11/24/17 she had been seeing a lung specialist but was waiting on insurance to allow pet scan

  6. So my son had an MRI 3/21/18. We just received notice on 3/30 that it was not approved by insurance pending further information. The MD office sent the PA the same day the MRI was completed-although this test had been scheduled for over 2 months. If insurance denies the MRI (which also included sedation with anesthesia) will we be responsible for the mri, sedation, and anesthesia?

    • Hi Sarah,
      Each insurance company has their own policies regarding prior authorization, but the key word is “prior”. Ideally, you want the request submitted in enough time to allow for an appeal if the procedure is denied. I’m crossing my fingers on your behalf. If it is denied, be sure to solicit the help of your physician to write a strong appeal letter.

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