High-tech imaging costs are now a major factor driving up the cost of health care. To help make sure that the type of technology chosen matches the type that's needed, BlueCross BlueShield of Tennessee is asking doctors and hospitals to use a prior authorization process.
Any time a doctor in Blue Network P or S recommends an outpatient MRI or other high-tech imaging test, the test or procedure must be authorized in advance. No authorization is needed for the tests in an emergency or as part of an inpatient hospital treatment plan.
The types of high-tech imaging services included are magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), magnetic resonance spectroscopy (MRS), computed tomography (CT scans), computed tomography angiography (CTA scans), positron emission tomography (PET scans), and nuclear cardiology.
If a Blue Network doctor suggests one of these outpatient procedures, it's important to know that:
Your Blue Network doctor or hospital should request prior authorization for these tests or admission. However, it is your responsibility to get prior authorization before receiving these services from a provider that is not in your network or outside the state of Tennessee. If you do not receive prior authorization for these services, you will often have to pay all or a larger share of the costs.
To begin your prior authorization review for a high-tech imaging procedure, call the number on the back of your BlueCross BlueShield of Tennessee member ID card.