MRI
| On 1 month ago

Why is an MRI not Covered by Insurance?

By Concierge at AffordableScan | 4 min read

An MRI (magnetic resonance imaging) scan is a type of medical imaging that uses powerful magnets and radio waves to produce detailed images of the inside of the body. These scans are often used to diagnose a wide range of conditions, from torn ligaments to cancer.

If you’re considering getting an MRI, you may be wondering whether your insurance will cover the cost. The answer to this question depends on a few factors, including the type of insurance you have, the reason for the MRI, and any preexisting conditions you may have.

In this blog post, we’ll explore the different types of insurance and what they cover, how to find out if your insurance will cover an MRI, and what to do if your insurance doesn’t cover the cost.

Types of medical insurance

There are several different types of insurance that can cover the cost of an MRI. These include:

  • Private insurance with full coverage: This is the most common type of insurance that covers medical expenses, including the cost of an MRI. Health insurance plans are typically offered through employers or purchased individually. Lately these plans are no longer offered by employers due to increase in insurance cost. Instead many companies opt for offering high-deductible insurance plans instead.
  • Medicare: This is a government-funded insurance program for people over the age of 65 or those with certain disabilities. Medicare will cover the cost of an MRI if it is medically necessary and ordered by a doctor.
  • Medicaid: This is a government-funded insurance program for low-income individuals and families. Medicaid will cover the cost of an MRI if it is medically necessary and ordered by a doctor.
  • Worker’s compensation: This type of insurance is provided to employees who are injured on the job. If an MRI is necessary to diagnose and treat a work-related injury, worker’s compensation will typically cover the cost.
  • Private insurance with a high-deductible plan: If you don’t have government funded insurance such as Medicare/Medicaid, you may be able to purchase private insurance to cover the cost of an MRI. High-deductible insurance covers the MRI but only once your yearly deductible has been reached. This means that until you reach your $6,000 or $12,000 family deductible you are asked to pay the full sticker price which is often 2-3x of what insurance ends up paying due to their negotiation powers.

The first step in determining whether your insurance will cover the cost of an MRI is to check with your insurance provider. Most insurance companies have a website or customer service hotline that you can use to find out what is covered under your plan.

Will my insurance cover an MRI?

When you contact your insurance provider, be prepared to provide the following information:

  • The reason for the MRI: You’ll need to explain why you need the MRI and provide any relevant medical information, such as the name of the condition you’re being treated for or the symptoms you’re experiencing. This will help the insurance company determine whether the MRI is medically necessary and therefore covered by your plan.
  • The type of MRI: There are different types of MRI scans, including MRI with contrast, MRI without contrast, and MRI of the spine. Make sure to let your insurance provider know what type of MRI you need, as this can affect whether it is covered by your plan.
  • The facility where the MRI will be performed: Some insurance plans only cover MRIs performed at certain facilities. If you’re unsure where you’ll be getting the MRI, your doctor’s office can provide this information.

Once you’ve provided this information to your insurance provider, they will be able to tell you whether the MRI is covered by your plan and, if so, what your out-of-pocket expenses will be.

Not sure where to start?

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What if my insurance denies my MRI scan?

Pay in cash or with credit card and save thousands on MRI fees

The great news is that with a standalone clinic you can always negotiate a better rate if you pay in cash. The imaging center saves on billing costs and removes the hassle of dealing with insurance companies, so they can provide you with large discounts. You can pay as little as $225 for an MRI scan without contrast. Which means you will save up 80% vs. the list price that you will be quoted by your insurance company.

Outpatient facilities have more affordable MRI costs than hospitals

Hospitals directly refer their patients to their imaging facilities, so they are not directly motivated to provide affordable service. Especially research hospitals such as UCSF or Stanford are among the most expensive in the country. For instance, 2 years ago Stanford charged a patient $23,749 for a single MRI.

MRI cost by state

Find out the average MRI cost by your state for insured and uninsured patients.

AlaskaKentuckyNevada
AlabamaLouisianaNew York
ArkansasMassachusettsOhio
ArizonaMarylandOklahoma
CaliforniaMaineOregon
ColoradoMichiganPennsylvania
ConnecticutMinnesotaSouth Carolina
DelawareMissouriTennessee
FloridaMississippiTexas
GeorgiaMontanaUtah
HawaiiNorth CarolinaVirginia
IowaNorth DakotaWashington
IdahoNebraskaWisconsin
IllinoisNew HampshireWyoming
IndianaNew Jersey
KansasNew Mexico

MRI costs by procedure type

Find out the average prices for most frequent imaging procedures:

CPT CodeMRI procedure TypeLowest cash priceHigh deductible co-pay price
70551MRI Brain without Contrast$225$1,328
70552MRI Brain with Contrast$350$1,692
70553MRI Brain w/o & w/ Contrast$400$2,054
72148MRI Lumbar Spine without Contrast$225$1,328
72149MRI Lumbar Spine with Contrast$350$1,692
72158MRI Lumbar Spine w/o & w/ Contrast$400$2,065
72141MRI Spine Cervical without Contrast$400$1,328
72142MRI Spine Cervical with Contrast$225$3,919
72156MRI Spine Cervical w/o & w Contrast$350$2,065
74181MRI Abd without Contrast$225$1,328
74182MRI Abd with Contrast$350$1,692
74183MRI Abd w/o & w/ Contrast$400$2,065

Tips for getting an affordable MRI scan

  • Shop around for the best price for both MRI & CT scans
  • Don’t hesitate to ask for discounts for MRI & CT procedures and negotiate to get the best rate possible.
  • Ask about all the fees for your body part MRI. Do they include the cost of MRI, cost of the radiologist reading?
  • Take your doctor’s referral with you to another facility. Your referral might be issued to one of the most expensive hospitals in the country.
  • See if you qualify for a better insurance plan that will cover your imaging services needs.
  • If you have a musculoskeletal issue don’t need to use the 3T MRI machine, which is considered the Ferrari of the imaging world, a simple 1.5T machine that cost fraction of it will suffice.

Not sure where to start?

SEE HOW MUCH YOU CAN SAVE
Our concierge will help you find the most affordable imaging center.
Concierge at AffordableScan | 4 min read

The concierge team at AffordableScan works with top experts & doctors in the industry to publish the latest research & news on medical care in the US.