Prior approval program information

High-tech imaging (scanning) procedures are one of the most rapidly rising medical expenses. The following high-tech scans are not only causing premiums to increase; most are exposing patients to higher doses of radiation.

• PET scans
• CT scans
• MRI/MRA
• Nuclear cardiology

What is Health Advantage doing to help?

Health Advantage has implemented a program that requires physicians to obtain an authorization when ordering outpatient high-tech imaging procedures for their patients. Physicians are not required to obtain an authorization when these services are performed in an emergency room, observation bed stay or for patients who are hospitalized.

Simplifying the process

The approval process generally is fast and efficient but, as with any new program, there have been minor glitches. Health Advantage is working to simplify the process for physicians.

What employers need to know

• If the physician fails to get an authorization, your covered employee will not be held financially responsible if the service is provided by an in network facility.
• The imaging facility may not perform the scan on your covered employee until an authorization has been received.
• Prior approval is not a guarantee of payment. Your employee’s benefit plan may have exclusions or limitations that may apply.

For more information

Contact the ArkansasBlue welcome center in your area.