Cigna MRI Prior Authorization Process Explained

Cigna MRI prior authorization is a process that ensures you get the necessary tests and treatments before undergoing an MRI.

To start the process, you'll need to contact your primary care physician or a specialist who has referred you for the MRI.

They will review your medical history and determine if the MRI is medically necessary.

Cigna's prior authorization process typically takes 2-3 business days to complete.

Precertification can be a complex process, but knowing where to start can make a big difference. Precertification requests for medical procedures, medications, and behavioral services should be submitted to Cigna Healthcare and national ancillary vendors.

To submit a precertification request, you'll need to know the right place to start. Cigna Healthcare and national ancillary vendors have specific guidelines for submitting precertification requests.

Here are the steps to follow:

Cigna Healthcare has a program to help you make informed choices about high-technology radiology services. If your doctor requests approval for an MRI, CT, or PET scan, a representative will contact you to discuss alternative, in-network facilities that offer the same services at a lower cost.

Cigna has made significant changes to its prior authorization requirements, and it's essential to understand what these changes mean for you.

Cigna is no longer requiring prior authorizations for nearly 25% of medical services, which is a huge reduction from previous requirements.

This change brings Cigna's total prior authorization removals to over 1,100 since 2020, with plans to remove more than 600 prior authorization codes in its commercial plans.

If you have a Cigna Medicare Advantage plan, you can expect even more codes to be removed, with over 500 codes being nixed by the end of the year.

With Cigna's new cutback, fewer than 4% of procedures are now subject to prior authorization for commercial policyholders, which covers 16.5 million people.

Cigna is removing prior authorizations for more than 100 surgical codes and nearly 200 genetic testing codes, along with a range of durable medical equipment, orthoses, and prosthetics.

Here are some specific examples of what's being removed:

These changes are part of a broader trend of payers rolling back prior authorization requirements in response to rising patient and provider criticism that prior authorizations are bottlenecking care.

The federal government is also taking steps to streamline the process, with the CMS proposing a rule to automate prior authorization and return decisions more quickly.

Some states, like Pennsylvania and Texas, have also moved to ameliorate prior authorization burden on doctors, requiring commercial insurers and Medicaid plans to provide a more streamlined approval process for non-urgent and emergency services.

You can compare costs by contacting the Informed Choice call representative or visiting myCigna to review average prices for scans at various facilities.

Other facilities outside of hospitals typically offer the same scan services at a lower cost, often with early and late hours, as well as free parking.

Cigna Healthcare reviews facilities in your plan's network to ensure they meet their standards, and choosing lower-cost options can help reduce healthcare and insurance costs.

Choosing higher-cost alternatives may result in higher deductibles and out-of-pocket costs in the future.

You may also want to consider the convenience of a facility, such as early morning or late hours, or one that's closer to your home, doctor's office, or work.

To get a Cigna MRI prior authorization, you'll need to provide your doctor's contact information, including their name, phone number, and fax number.

Your doctor will need to submit a written request for the MRI, including a detailed description of the procedure and the medical necessity of the test.

Cigna requires that the doctor's request includes the patient's diagnosis, medical history, and any relevant test results.

The doctor's office will need to contact Cigna's customer service department to initiate the prior authorization process.

Cigna's customer service team will review the doctor's request and make a decision on the prior authorization within 2-3 business days.

The doctor will be notified of the decision via phone or fax, and the patient will also receive a notification.