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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 You Need To Know
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If your physician fails to get an authorization, you will not be held financially responsible
if the service is provided by an in network facility.
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The imaging facility may not perform the scan until an authorization has been received.
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Prior approval is not a guarantee of payment. Your benefit plan may have exclusions or limitations that may apply.
For More Information
Contact the Regional Office in your area.
*For more information, download Blue & You Winter 2005 (PDF), and read pages 16-18.
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