Is My MRI Covered By My Insurance?

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 also influence your out-of-pocket costs.  

Insurance companies reserve the right to decide whether or not a procedure such as an MRI is medically necessary. Most insurers require what’s called a “medical necessity review” for all CT and MRI requests. The companies use these reviews to decide whether a given test is appropriate and essential. They make these determinations based on three factors: the policies and clinical guidelines of the patient’s health plan and the overall standard of care. 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 as your insurer.  

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). 

In general, medical imaging is not cheap. According to Forbes, MRI scans typically cost between $500 and $3,000. If an MRI is approved as medically necessary in the review process, it will often be covered. Still, patients must meet their deductible before the insurance covers the cost. In that scenario, you not only may have to pay the total fee of the MRI if you haven’t yet hit the annual deductible—you might also end up paying a higher price than usual depending on the pricing negotiated with the provider by your insurer.  

That deductible—which is what you are on the hook to spend on covered medical care before the insurer begins to pay for it—could be $2,000 or $3,000, which means you very easily could be stuck with the complete MRI bill if you had not yet accessed any other healthcare services that year. Even after you move past the deductible, you may still be required to make a copayment or coinsurance payment for any covered services beyond physicals and other basic care. Many people find it challenging to meet their deductible; even when they do, they may face 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, affordable services at quality centers and also lower 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 they 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. Click here to find out if your MRI will be covered by insurance or if there’s a cheaper option.