Are MRIs Covered by Insurance? Insurance Coverage Your coverage depends on the individual policy you have. Many insurance plans require prior authorization for an MRI, and you also may need to get the scan at an in-network facility. But MRIs are typically covered when they’re ordered by a doctor and considered medically necessary. Common reasons for having one include:e60dc2a1-f33c-4a05-9b50-8e3e8e5976290d7f638c-e469-4f57-8d52-52c68aa69f8fe60dc2a1-f33c-4a05-9b50-8e3e8e59762904c26867-6bfc-4ff3-8d09-233c94d55c90 Diagnosis or evaluation of a specific medical condition Monitoring the progress of a known medical condition Imaging prior to surgery, such as joint replacement or tumor removal Evaluation of an acute injury after an accident or for severe pain Management of chronic conditions, particularly those impacting the brain, spine, or joints
What Should I Do if My Insurance Won’t Cover an MRI? When Insurance Doesn’t Cover It Your insurance may deny coverage for these common reasons:e60dc2a1-f33c-4a05-9b50-8e3e8e597629967b10db-42be-4eba-8160-4a0c734f4158 It’s not considered medically necessary. You’re not eligible under your specific health plan. The MRI is considered experimental for your condition. The claim was filed too late. If you receive a denial letter, it should include detailed information about your right to file an appeal , including the specific reason that the claim was denied and the deadlines for appeals. You have 180 days to file an internal appeal. If that fails, you can request an external review by an independent party. If the appeals process is not successful, consider having an MRI at a freestanding MRI center, which is usually less expensive than a scan performed at a hospital. If you are not using insurance, you should ask for the cash price and a good faith estimate. The American College of Radiology’s search tool allows you to look for accredited imaging facilities near you.
Resources We Trust Mayo Clinic: MRI Cleveland Clinic: Brain MRI Centers for Disease Control and Prevention: Facts About Imaging Procedures MD Anderson Cancer Center: CT Scan vs. MRI: What’s the Difference? HealthCare.gov: Appealing a Health Plan Decision
Cost: Hospital vs. Private Provider Hospital vs. Private Provider MRIs are performed in hospitals, hospital outpatient departments, and freestanding imaging centers. Some urgent care centers also offer MRI services, but most do not. MRIs performed in hospitals or hospital outpatient departments may be pricier than those performed at a freestanding radiology center.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e5aae869-be7a-49ff-895f-5eba233a3f8e There can also be cost variations from one hospital to another. One study found that brain MRIs, for instance, are cheaper at for-profit hospitals than nonprofit ones, and rural hospitals are more expensive than urban ones.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d4baa1a6-87e5-4ab5-a702-11968cb885d1 If you have Medicare Part B, 80 percent of the cost of an MRI will be covered once you meet your deductible . If you get the test at a hospital as an outpatient, you will also pay the hospital a copayment. If you get the test from a physician’s practice, clinic, or freestanding radiology center outside of a hospital, make sure the facility is accredited. Medicare won’t pay for the test if it isn’t.e60dc2a1-f33c-4a05-9b50-8e3e8e59762940b4da4b-f397-40b2-8e57-4cea459f276d
Is There Usually a Large Copay? Copay Expenses The amount you’re expected to chip in depends on your plan. What you are expected to pay may come in the form of coinsurance rather than a copay. Both terms refer to how much a patient will owe for healthcare costs, but a copayment is a set dollar amount, while coinsurance is a percentage of the total cost. If you have a deductible, you will have to meet that first before your insurance company will pay.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294f79070b-e034-4645-a736-543bbd0de41f A common coinsurance arrangement is for the insurance company to pay 80 percent of the costs, leaving the patient responsible for 20 percent.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cb90cb3d-89f6-419f-b62b-0453e52aa381 To determine your exact cost, check your insurance plan for details. If you need clarification about your coverage, call your insurance company directly. When you’re scheduling a doctor-recommended MRI, ask the facility where it will be performed for a cost estimate and any copay or coinsurance responsibilities. Hospitals must post prices for “shoppable” services, which often include MRIs.e60dc2a1-f33c-4a05-9b50-8e3e8e597629763568f4-5d86-4e13-81b3-48d2cfc37f52
What Factors Affect the Cost of an MRI? What Factors Affect the Cost of an MRI? The biggest factors that drive variations in MRI costs include geographic location, your health insurance plan, and the facility where you get the scan. Comparing prices at different imaging centers will help you find the most affordable rate. Your doctor’s office should have trusted imaging centers in your area that they can recommend, and you can also use healthcare cost comparison websites to find the cheapest option.
Is an Open MRI More Expensive? Open MRIs Not necessarily. An open MRI is a machine with a large opening rather than a tubelike structure. It may cost more or less than a traditional MRI, depending on the facility, the type of equipment, and the price negotiated with your insurance plan. The machinery and maintenance costs for open MRIs are lower, so that may translate into lower costs for the consumer.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fdb2025b-dc7c-4276-a909-d84ed60f812e Open MRI machines are a better option for those who have claustrophobia , since there’s open space on two sides. On the other hand, the images they capture may not be as clear.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b804d292-d283-417b-ad44-56070735a3e6
Magnetic resonance imaging (MRI) is a painless, noninvasive scan that uses a magnet, radio waves, and a computer to create detailed images of organs and tissues. MRIs are a powerful tool used to diagnose and monitor medical conditions throughout the body.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296aaefb32-0bac-4040-87cf-a5fb50f224b0 The cost of an MRI scan can vary, depending on your health insurance plan , geographic location, provider, and other factors. According to healthcare cost data, the average price for an MRI in 2022 was almost $2,000.e60dc2a1-f33c-4a05-9b50-8e3e8e597629dc9bed88-2797-4918-8be1-2324a267a842 However, it can run considerably higher, depending on the area of the body that’s scanned and the facility where the scan is conducted. If you have insurance, the out-of-pocket cost is usually considerably less.
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