Does CIP (PPO) require prior Auth for MRIs?

[wehotex]

An Aetna Medicare PPO member called to tell me that a local hospital would have to obtain prior auth for his MRI. I’ve always thought that PPOs would require prior auth, but more “relaxed”. When I looked in the Aetna PPO EOC, I found that the MRI (and other services) have wording that says that “may require Prior Auth”. The CIP lacks such wording. I don’t exactly think that it would be the case. Anybody have any experience with these Medicare PPO situations?

 

[bluediamond]

An Aetna Medicare PPO member called to tell me that a local hospital would have to obtain prior auth for his MRI. I’ve always thought that PPOs would require prior auth, but more “relaxed”. When I looked in the Aetna PPO EOC, I found that the MRI (and other services) have wording that says that “may require Prior Auth”. The CIP lacks such wording. I don’t exactly think that it would be the case. Anybody have any experience with these Medicare PPO situations?

Don't know about the particular company you asked for but I believe just about every other company requires a pre auth, otherwise, anyone with an ache or pain could walk in and demand an MRI costing the insurance companies many fruitless claims. If you clients primary ordered it they should have had enough sense to get a pre auth.