What to Know About CT Scan Pre-Authorization

Your doctor ordered a CT scan, but your insurance company says it needs pre-authorization first. What does that mean, and how long will it take? Here is everything you need to know.

What Is Pre-Authorization?

Pre-authorization (also called prior authorization or pre-cert) is your insurance company confirming that a procedure is medically necessary before they agree to pay for it. For CT scans, this is a common requirement.

The American Medical Association reports that 94% of physicians say prior authorization delays necessary care. Knowing the process can help you avoid setbacks.

Why Do Insurers Require It?

Insurance companies use pre-auth to:

• Confirm the scan is appropriate for your symptoms
• Check whether a less expensive test (like an X-ray or ultrasound) should be done first
• Ensure the scan meets their clinical guidelines
• Control costs

Not every plan requires pre-auth for CT scans. Medicare, for example, typically does not require prior authorization for outpatient imaging. Check your specific policy.

How the Process Works

1. Your doctor submits a request — They send your clinical information (diagnosis, symptoms, prior treatments) to the insurance company
2. Insurance reviews the case — A nurse or medical director evaluates whether the scan meets their criteria
3. Decision is made — Approval usually comes within 1 to 3 business days, but it can take up to 5
4. You schedule the scan — Once approved, you can book your appointment

What Can Cause a Denial?

Common reasons for CT scan pre-auth denial:

• Incomplete clinical information — Your doctor did not provide enough detail
• Step therapy required — The insurer wants you to try another test first
• Wrong diagnosis code — A coding error on the request form
• Out-of-network facility — The insurer may deny coverage at certain locations

What to Do If Denied

A denial is not the final answer. Your doctor can:

• Submit additional clinical records
• File a peer-to-peer review (your doctor speaks directly with the insurance medical director)
• File a formal appeal

At Advanced Medical Imaging, our authorization team works directly with your insurance to resolve denials quickly. We handle the paperwork so you can focus on your health.

How AMI Helps Speed Things Up

When you schedule a CT scan at AMI, our team:

• Verifies your insurance benefits before your visit
• Submits pre-authorization requests on your behalf
• Follows up with the insurance company to avoid delays
• Notifies you as soon as approval is received

We accept most major insurance plans and offer affordable self-pay options if you prefer to skip the authorization process entirely.

Tips for Patients

• Ask your doctor to submit the request early — Do not wait until the day of your scan
• Provide your insurance card at scheduling — This gives us time to verify benefits
• Keep your phone nearby — We may need to reach you with questions
• Know your plan — Some HMOs always require pre-auth; some PPOs do not

Schedule Your CT Scan

Need a CT scan in the Tampa Bay area? Call Advanced Medical Imaging at (727) 398-5999 or book online. We are located at 9555 Seminole Blvd, Suite 101, Seminole, FL 33772.

Sources: - AMA — Prior Authorization Reform - CMS.gov — Medicare Coverage Information