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Prior Approval Program Information
High-tech imaging (scanning) procedures are one of the most rapidly rising medical
expenses. The following high-tech scans are not only causing premiums to increase;
most are exposing patients to higher doses of radiation.*
- PET scans
- CT scans
- MRI/MRA
- Nuclear cardiology
What is Arkansas Blue Cross and Blue Shield doing to help?
Arkansas Blue Cross has implemented a program that requires physicians to obtain
an authorization when ordering outpatient high-tech imaging procedures for their
patients. Physicians are not required to obtain an authorization when these services
are performed in an emergency room, observation bed stay or for patients who are
hospitalized.
Simplifying The Process
The approval process generally is fast and efficient but, as with any new program,
there have been minor glitches. Arkansas Blue Cross is working to simplify the process
for physicians.
What You Need To Know
- If your physician fails to get an authorization, you will not be held financially
responsible if the service is provided by an in network facility.
- The imaging facility may not perform the scan until an authorization has been received.
- Prior approval is not a guarantee of payment. Your benefit plan may have exclusions
or limitations that may apply.
For More Information
Contact the Regional Office in your area.
*For more information, download Blue & You Winter 2005 (3 MB PDF), and read pages 16-18.
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