Are MRI scans covered by private health insurance?

If you need to get an MRI it’s worth being across the upfront costs that could set your budget back, and how insurance and Medicare can help.

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MRIs are a non-invasive testing option for diagnosing myriad medical conditions, but they can come at a premium cost.

Here we reveal how much will Medicare contribute to the cost, and where private health insurance comes into it.

What is an MRI?

An MRI (Magnetic Resonance Imaging) is a safe, non-invasive imaging procedure that uses radio waves and a strong magnetic field to photograph inside different parts of the body. It’s a scan that allows health practitioners to investigate and diagnose conditions in the body’s soft tissues, organs and skeletal system without the need for invasive surgery.

Some of the most common medical conditions MRIs are used to diagnose may include brain disorders, multiple sclerosis, spinal cord disorders, stroke, liver disease, traumatic injuries, infection, eye and inner ear disorders, knee and shoulder injuries, aneurysms, tumors, heart issuesspine disease and blood and vessel disorders.

MRI scans can provide detailed images of soft tissue, but it doesn’t photograph bone as effectively. This is why bone injury or disease is usually investigated with an X-ray examination instead.

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How much does an MRI cost?

MRIs are large, sophisticated and expensive machines that are found in larger hospitals and specialized centers and their use does come at a cost to consumers. Depending on the reason for the MRI, the area of ​​the body being scanned and the type of MRI machine required, most MRI scans will cost between $ 100 and $ 500, however, there are some MRI tests that can set you back almost $ 1,500.

According to the Australian Diagnostic Imaging Association, many Australians face an upfront cost barrier when seeking an MRI because you could have to cough up an average of $ 523. The good news is that Medicare may partially or fully rebate some of the cost, but typically not until after the upfront fee is paid; the average gap (out-of-pocket costs) consumers pay for an MRI is $ 200.

Whether you’re eligible for a Medicare rebate on your MRI will depend on the following:

Who referred you for the MRI. To be eligible for a Medicare rebate, a specialist or, in some cases, your GP, will need to have referred you for the MRI, However, this can vary widely and depends on the type of scan required.

The type of test you have. How much Medicare will reimburse you also varies considerably between the type and extent of the MRI testing required. MBS eligibility and extent varies considerably as there are specialized types of MRI machines that test different parts of the body.

Where you are having the test done. If you are a public inpatient at a public hospital, and your medical specialist refers you for an MRI as part of your treatment, then you are eligible for Medicare to cover the full cost of your MRI. However, if you’re an outpatient (not a patient in hospital) and have an MRI at a clinic, expect to foot some out-of-pocket costs for the scan. Clinics can charge different rates for their services, so discuss the cost of your MRI directly with your chosen clinic before your test so you know what your out-of-pocket costs will be.

It’s important to note that if your MRI is covered by the MBS, you’ll be required to pay the full cost of the MRI upfront before you can claim a rebate.

Can I claim MRI scans on private health insurance?

It depends. If you are a private patient in a public or private hospital, you may be eligible to make a claim on your private health insurance, depending on your policy’s cover and if the Medicare rebate for your particular test is insufficient.

As a private hospital patient, should your specialist require you to have an MRI, you or your private health insurer is expected to fork out any out-of-pocket costs above the Medicare rebate. Also, it’s important to note that if the type of MRI test is not on the MBS and therefore ineligible for a Medicare rebate, your health fund will not contribute to the cost of the scan.

If you’re an outpatient and visit a clinic for an MRI scan, regardless of your health insurance policy, you will not be able to claim on your private health insurance to cover your out-of-pocket costs. You can only make a claim as a hospital inpatient.

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What to look for in health insurance policies that cover MRI scans

Private health insurance offers convenience, choice and peace of mind should you find yourself in hospital requiring treatment. As a private patient, you want to ensure you receive all the benefits your policy can offer while also minimizing your out-of-pocket costs. So, when choosing your private health insurance, you’ll need to read the fine print to ensure your chosen policy will cover you for all necessary MRI scans should you require one while in hospital.

MRI scans are not listed as a ‘clinical category’ on their own for private health insurance, which can make it tricky to compare policies in relation to their cover specifically for MRI. Instead, seek out policies that cover the more common health concerns that may require MRI scans for diagnosis to compare.

For example, common medical conditions MRIs are used to diagnose stroke and heart issues. The clinical category for this area is known as ‘Heart and Vascular System’. Gold and Silver tiered hospital cover will always provide cover for this category, however, for Bronze and Basic tiers, this cover is optional (and restricted for Basic). This means that it’s up to the individual insurer whether they include it in a particular policy.

So, while you cannot use a health insurance comparison service to search for MRI cover, you can determine whether a policy is right for you by comparing policies with relevant clinical categories that may require MRI scans for diagnosis.

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