Wiki Pre-Authorization for STAT Imaging Orders

[rosse126]

My colleagues and I are having a disagreement on STAT Imaging Orders needing pre-authorization; some STAT Imaging Orders don't need pre-auth (based on the health plan) and some do (based on the health plan).

Where can I find info, articles and/or documents about STAT Imaging Orders needed pre-authorization? I don't seem to find any.

 

[csperoni]

Each insurance company determines their own policy regarding what tests or type of tests require pre-auth. Even within the same carrier, you may find one plan that requires it and one plan that does not.
I will note - I have never seen this differ regardless if the test is ordered as STAT. I do not think there is anything different the imaging facility bills, so the requirements would be the same. If Aetna Medicare requires pre-auth for CT of the abdomen with contrast, they will require it regardless of whether or not it's STAT.

 

[MagentaMoon67]

My colleagues and I are having a disagreement on STAT Imaging Orders needing pre-authorization; some STAT Imaging Orders don't need pre-auth (based on the health plan) and some do (based on the health plan).

Where can I find info, articles and/or documents about STAT Imaging Orders needed pre-authorization? I don't seem to find any.

csperoni is correct, if an authorization is required, its required regardless of the timing. The only exception would be if the patient was in the ER... I work for an insurance carrier, and we do not deviate from requiring pre-auth for certain procedures/tests, but that likely differs depending on the carrier. We do have some advanced imaging that we allow without an authorization, but you would need to verify that with the patients insurance company.