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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 Employers Need To Know
- If the physician fails to get an authorization, your covered employee will not
be held financially responsible if the service is provided by an in network
facility.
- The imaging facility may not perform the scan on your covered employee until an
authorization has been received.
- Prior approval is not a guarantee of payment. Your employee’s benefit plan may
have exclusions or limitations that may apply.
For More Information
Contact the
Local Office in your area.
*For more information, download Blue & You Winter 2005 (PDF), and read pages 16-18.
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