Does private health insurance cover MRI scans?

Does private health insurance cover MRI scans?

The simple answer is: yes! Private health insurance can cover MRI scans when they are required to investigate or diagnose a medical condition listed under the terms of your policy.

MRI scans fall under the umbrella of ‘diagnostic imaging’ and private medical insurance is generally designed to cover the investigation and treatment of short-term medical conditions that begin after your policy starts. Diagnostic tests such as MRI scans, CT scans, ultrasounds, and X-rays may therefore be included.

However, health insurance policies vary considerably, so be careful not to assume that a scan will be covered simply because they appear within your policy documents. Getting in touch with your insurance provider will confirm whether:

• the medical condition is covered
• the scan is clinically necessary
• you have the correct referral
• the chosen hospital and specialist are approved
• you have followed the insurer’s authorisation process.

Some resources you may find helpful:

• Guide to using private medical insurance

When is an MRI scan likely to be covered?

An MRI scan is more likely to be covered when a GP, physiotherapist, or specialist believes it’s needed from a medical point of view to further investigate your symptoms.

For example, an MRI may be requested to help diagnose or monitor:

• joint, muscle, or ligament injuries
• persistent back, neck, hip, or knee pain
• damage to soft tissue
• problems affecting the brain or spinal cord
• conditions affecting internal organs
• symptoms that cannot be fully investigated using an X-ray
• your response to an existing treatment.

The exact conditions included will depend on your policy. Even where diagnostic imaging is covered in principle, an insurer may place limits on the number or value of diagnostic tests you can claim for.

When might an MRI scan not be covered?

There are several reasons an insurance provider may not agree to pay for an MRI scan. These are listed and detailed below.

The condition began before your policy started

Private medical insurance usually focuses on new, short-term conditions. If you were already experiencing symptoms, undergoing investigations or receiving treatment before taking out the policy, your insurer may class the problem as a pre-existing condition.

Please contact your insurance provider before booking. They will be able to confirm the specific terms and rules of your policy.

The scan is for routine screening

An MRI requested as part of routine health screening – rather than to investigate specific symptoms – may not be covered.

For example, an insurer may treat a full-body MRI scan differently to a scan requested by a doctor to investigate persistent knee pain.

You have not obtained authorisation

Even when the condition and scan are covered, your insurer may decline payment if you book the MRI before receiving authorisation.

Always get in touch with your insurer to obtain an authorisation code before confirming your appointment.

The provider or specialist is not approved

Some insurance policies restrict patients to a list of recognised hospitals, radiologists, or consultants. If you’d like to book an MRI with Practice Plus Group, you’ll need to tell your insurer before the scan is approved.

Your outpatient limit has been reached

Some policies place an annual financial limit on the number of consultations and diagnostic tests you can have. Your insurer can tell you whether your MRI falls within this allowance.

How to check whether your MRI is covered

The most reliable way to find out is to give your private medical insurance provider a call.

Make sure you have the following information to-hand:

• your policy or membership number
• the symptoms or condition being investigated
• details of your GP or specialist referral
• the type of MRI requested
• the body part being scanned
• your preferred Practice Plus Group location
• the name of your consultant, where applicable.

There may be a lot to cover and a chunk of information to take onboard, so it’s a good idea to prepare for the call. You might want to ask your insurer the following questions:

During the call, be sure to make a note of who you spoke to and, once it’s over, keep your authorisation code somewhere safe.

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How to book an MRI scan through private health insurance

Booking an insured MRI scan usually involves the following four straightforward steps.

Step 1: Get referred

Speak to your GP, physiotherapist or specialist about your symptoms. If they believe an MRI is appropriate, they can provide a referral explaining which area of the body needs to be scanned and why.

Referral requirements can vary between insurers and Practice Plus Group locations, so check what documentation is needed.

Step 2: Confirm your insurance cover

Contact your insurer and provide the details from your referral. Don’t forget to mention us! Tell them you would like to have your MRI scan at Practice Plus Group.

Your insurer will check that the scan, medical condition, and chosen provider (hopefully us!) are covered by your policy.

Step 3: Get an authorisation code

If your claim is approved, your insurer will issue an authorisation code.

This code confirms that your insurer has authorised the scan financially. You will need to keep it handy when arranging your appointment.

Step 4: Book your MRI scan

Contact Practice Plus Group with your referral, insurance details, and authorisation code.

Our lovely and friendly private patient team will confirm availability at the hospital of your choice and guide you through the remaining booking requirements.

Do you need a GP referral for an insured MRI?

Most insured patients will need a referral before their insurer can authorise an MRI scan.

This referral will normally come straight from your GP or another recognised healthcare professional. It will likely explain your symptoms, the area of the body that needs scanning, and the clinical reason for requesting an MRI.

Some insurance providers offer direct-access pathways for certain conditions, particularly for musculoskeletal problems. Be careful not to assume that you can self-refer simply because the option is available to some self-pay patients.

If in doubt – ask your insurer whether a referral is required before booking.

Will you have to pay towards your MRI scan?

Your private medical insurance may pay all or part of the cost of your MRI.

The amount you need to pay yourself will depend on the following factors:

• your policy excess
• any co-payment or cost-share agreement
• your remaining outpatient allowance
• whether every part of the scan is authorised
• whether contrast media or another additional service is needed
• any limits applying to your hospital or specialist.

An excess is the amount you have agreed to contribute towards private healthcare claims. For example, if your policy has a £100 excess, you’ll likely need to pay the first £100 of an eligible claim.

Practice Plus Group will invoice your insurer directly for treatment that’s been authorised, but it’s important to remember you remain responsible for any excess or costs your policy does not cover.

Which insurers does Practice Plus Group work with?

At Practice Plus Group, we work with all the major UK private medical insurance providers. These include:

• Allianz
• Aviva
• AXA Health
• Bupa
• Healix Health Services
• National Police Healthcare Scheme
• Vitality
• WPA.

Being insured by one of these providers does not guarantee that your MRI scan will be covered. To be covered, the scan must:

• meet the conditions of your individual policy
• be authorised by your insurer.

Your insurance provider should also confirm that the Practice Plus Group hospital you wish to attend is included within your hospital network.

What if your insurance does not cover the scan?

A rejected insurance claim does not necessarily mean a private MRI scan is off the table.

First, ask the insurer to explain why the scan isn’t covered. The problem may be down to something resolvable like:

• missing referral information
• an incorrect procedure code
• the need for further clinical evidence
• the hospital not yet being added to the approval list
• an expired or incomplete authorisation code.

If the exclusion cannot be resolved, you may be able to pay for the MRI scan yourself.

At Practice Plus Group, current self-pay MRI prices are as follows:

Why choose Practice Plus Group for an MRI scan?

Whether you’re using medical insurance or paying for yourself, Practice Plus Group offers swift access to high-quality diagnostic imaging.

Short waiting times

Private MRI scans are typically available at a time to suit you following your initial enquiry.

Experienced imaging professionals

Your scan will be carried out by a trained radiographer. The images are then carefully reviewed and reported by an appropriately qualified radiology professional.

Fast results

Private MRI results are generally sent to your referrer within around three working days. Your referrer can then explain the findings and discuss any treatment or further investigations you may need.

A choice of locations

MRI scans are available at many Practice Plus Group hospitals and diagnostic centres. With that said, be sure to check the types of scan available at each different location.

Support for insured patients

Our private healthcare team strives to keep the booking process simple. Once your insurance company has confirmed your cover and provided an authorisation code, our advisers will guide you through the next steps.

Accessing healthcare via private medical insurance?

Practice Plus Group works with major private medical insurance companies to give insured patients fast access to consultations, diagnostic tests and treatment.

Before booking, ask your insurer to confirm that your MRI scan and preferred Practice Plus Group location are covered. Once you have your referral and authorisation code, contact our friendly team to arrange your appointment.