Is MRI covered by Aetna?
Asked by: Prof. Keon Hamill Jr. | Last update: December 2, 2025Score: 4.8/5 (11 votes)
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.
Does insurance fully 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 long does Aetna take to approve an MRI?
Once your doctor sends a request for prior authorization, Aetna reviews the request. During our review, we look at the most recent and highest quality medical research and guidelines. We update your care provider throughout the review process to keep them informed on the status, and come to a decision within 14 days.
Does Medicare pay 100% for MRI?
Medicare Part B may cover 80% of the cost for a medically required magnetic resonance imaging (MRI) scan ordered by a doctor. However, both the doctor and the facility performing the scan must accept Medicare patients.
Health Insurance Denials
Is a knee MRI covered by Medicare?
From 1 November 2018, the following changes to Medicare-funded knee imaging services are in effect: Patients aged 50 years and over are no longer eligible for an MBS rebate for knee magnetic resonance imaging (MRI) scans if they are referred for one by their GP.
Does Aetna pay for MRI?
Medical Necessity
Aetna considers magnetic resonance imaging (MRI) medically necessary for appropriate indications without regard to the field strength or configuration of the MRI unit. Aetna considers intermediate and low field strength MRI units to be an acceptable alternative to standard full strength MRI units.
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 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.
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.
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 do I know if my insurance covers MRI?
Contact your insurance provider: Reach out to your insurance company directly to inquire about MRI coverage and to request a list of in-network imaging centers or radiology providers. You can call the customer service number on your insurance card or visit their website to find the appropriate contact information.
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 won't my doctor send me for an MRI?
While MRIs are a great tool, they are often not ordered immediately unless the physical exam shows neurological deficits or the doctor thinks that you will probably need surgery.
Is Aetna expensive insurance?
Aetna is one of the cheapest health insurance companies and is good if you're on a budget. But Aetna's customer service is typically below average.
Which health insurance denies the most claims?
According to the analysis, AvMed and UnitedHealthcare tied for the highest denial rate, with both companies denying about a third of in-network claims for plans sold on the Marketplace in 2023, respectively.
What happens if you don't pay Aetna?
If full payment is not received by the end of the third month, the member's coverage will be terminated. This action is retroactive to the end of the first month of the grace period. If coverage is terminated, Aetna will not pay any pended claims for months two or three.
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 ...
Is an MRI free with insurance?
The total cost of an MRI depends on many factors, including health insurance, radiologist fees, and type of scan. Even with insurance, you should still expect some out-of-pocket expenses, such as deductibles, copays, and coinsurance. On average, an MRI costs $400 to $12,000.
What is out-of-pocket maximum Aetna?
Definitions: Out-of-pocket (OOP) max: The highest amount you could pay in a given year for services (excludes premium). Copay/coinsurance: The amount you pay per visit or prescription to treat an injury or illness. It typically counts toward your OOP max.
Do I need a referral for an MRI?
While there are some instances where you could get one of the imaging tests done without a referral, at most medical facilities, you will need a referral for CT scans, x-rays and MRIs. Often, your insurance type determines if you need a referral.
How to get an MRI quickly?
Private imaging centers: Private imaging centers often offer services on a fee-for-service basis. Since they don't have to deal with insurance pre-approvals and processing, they may be able to schedule your MRI appointment more quickly.