Getting Insurance to Cover a Recommended Scan

Most imaging — CT, MRI, PET, sometimes even advanced ultrasound — requires prior authorization before your insurer will pay for it. Your doctor's office usually submits this, but 'usually' is doing a lot of work in that sentence: a huge share of delayed scans trace back to a prior auth request that was never actually filed, not to insurance being slow. Call your insurer directly and ask three things: has a prior authorization request been received for this specific test, what's the reference number, and what's the expected decision date. Write down who you spoke to and when. If it's denied, the denial letter is required by law to state the specific reason and how to appeal — that's not a formality, it's your roadmap. Ask your doctor's office about a 'peer-to-peer review': a direct call between your doctor and the insurer's reviewing physician. It's one of the fastest ways a denial gets reversed, and it often happens before you'd even need to file a formal appeal.