Does Aetna cover MRI?
Asked by: Dr. Jolie Krajcik I | Last update: October 21, 2025Score: 4.6/5 (51 votes)
Does Aetna pay for MRIs?
Medical Necessity
Aetna considers functional magnetic resonance imaging (fMRI) medically necessary to identify the eloquent cortex in pre-surgical evaluation of persons with brain tumors (except temporal tumors), epilepsy (except temporal neocortical epilepsy), or vascular malformations.
Why does Aetna deny MRI?
Experimental, Investigational, or Unproven
Aetna considers the use of MRI for further evaluation of unstable injury in neurologically intact individuals with blunt trauma after a negative cervical spine CT result not medically necessary.
Are MRIs fully covered by insurance?
With insurance, the out-of-pocket cost for an MRI is typically lower, but it still depends on the individual's insurance plan, including deductibles, co-pays, and coverage limits.
Does Aetna require approval for MRI?
Some procedures (For instance, an MRI, CAT scan or surgery.) need approval in advance. Your doctor can ask for this approval up to six months ahead of time.
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Why won't my insurance cover an MRI?
Insurance denials for MRI scans or surgeries can happen due to various reasons, such as pre-authorization requirements, medical necessity disputes, or administrative errors. It's important to remember that denial doesn't necessarily mean you won't receive the necessary care.
What is the cheapest way to get an MRI?
To save money on an MRI, shopping around for the best price by comparing costs at different facilities is essential. Independent imaging centers often offer lower rates than hospitals, and many provide cash payment or self-pay discounts, especially for those without insurance or with high deductibles.
How much does an MRI scan cost privately?
How much is an MRI Scan? Prices start at €280, however, the exact price you can get will depend on how many areas were scanned and whether or not you required contrast.
How much does an MRI cost in the US?
On average, a brain MRI costs between $1,600 and $8,400 in the US; a neck MRI between $500 and $11,800; a chest MRI between $500 and $7,900; a breast MRI between $500 and $10,300; an abdominal MRI between $1,600 and $7,600; a pelvic MRI between $500 and $7,900; an MRI of the upper extremity between $1,050 and $7,000; ...
How do I get insurance to authorize my MRI?
It is important to note that insurance coverage for MRIs often requires pre-authorization or approval from the insurance provider. The healthcare provider or facility typically initiates this process, providing necessary medical information to justify the medical necessity of the MRI.
Will Aetna cover CT scans?
Medical Necessity
Aetna considers annual low-dose computed tomography (LDCT) scanning, also known as spiral CT or helical CT scanning, medically necessary for current or former smokers ages 50 to 80 years with a 20 pack-year or more smoking history and, if a former smoker, has quit within the past 15 years.
Why is Aetna not paying claims?
If you've had a health treatment or disability claim denied by Aetna, it could be because: The procedure is considered cosmetic (not medically necessary) Your doctor is out of network or doesn't participate in the plan. Your plan doesn't cover your medical condition.
Why would Aetna deny an MRI?
While it is unlikely that your insurer would deny your claim for an MRI scan by saying the procedure is experimental, it may claim the scan is “not medically necessary.” The insurance company may require your physician to first perform x-rays and a CT scan to determine the cause of your medical issue because those ...
Why is Aetna so expensive?
Factors influencing Aetna insurance monthly costs
Plans with broader coverage and extensive benefits, such as lower deductibles, co-pays, and comprehensive services like dental and vision care, often come with higher monthly costs.
Why is MRI so expensive even with insurance?
This high cost is partly due to the complexity of the machinery, which uses powerful magnetic fields and is cooled by liquid helium, consuming a significant amount of electricity. Additionally, the expertise required to operate and interpret MRI scans contributes to the high cost.
Can I pay for an MRI without a referral?
Can I get an MRI without a referral? While it is possible to get an MRI without a referral, medical referrals are important because your insurance may deny coverage without one, and diagnostic imaging can be expensive if you're paying out-of-pocket.
Is a private MRI worth it?
Private MRI scan centres typically offer faster results than traditional hospital-based imaging centres. At Vista Health, for example, patients can receive their results within 3 working days of their scan, allowing for prompt follow-up care if necessary.
How to lower the cost of MRI?
- If you have insurance, always contact them to verify your MRI is covered.
- Consider the out-of-pocket costs to see if skipping insurance is more cost-effective.
- Avoid MRIs at hospitals or emergency rooms when possible.
- Schedule a scan at an independent imaging clinic.
Does insurance cover MRI?
MRI scans are generally covered by insurance when they are deemed medically necessary, which typically includes situations where an MRI is required for diagnostic purposes or to monitor the progress of a known medical condition.
How to get an MRI asap?
Urgent medical need: If your healthcare provider determines that you have an urgent medical need for an MRI, they may expedite the process to ensure you receive timely care. This could be due to symptoms indicating a serious condition, such as severe pain, neurological issues, or suspected internal injuries.
How much is an MRI with Blue Cross insurance?
Patients insured by United are charged $995, Humana's $988, and Blue Cross' $464. In other words, depending on their insurance company, some patients may wind up paying $500 more for an identical procedure at the same facility. As is typical of health care pricing, they often won't know the price beforehand.
Does Medicare cover MRI?
Medicare typically covers MRI scans when your doctor determines that it's medically required to reach a diagnosis. MRI scans are classified as “ diagnostic non-laboratory tests (opens in new window) ” under Medicare Part B.
How do I get my insurance to approve an MRI?
Insurance: Prior insurance authorization may be required by your insurance company for your radiology study. Please confirm that you have insurance approval from your ordering physician. Please bring any insurance information (card and authorization) and examination requisition with you to the appointment.