- Radiological services such as CT, CTAs, MRIs/MRAs, PET scans and nuclear medicine and cardiovascular system procedures (myocardial imaging, myocardial infusion studies and cardiac blood pool imaging).
Where and When
- Before these services are provided in an Outpatient Hospital or Office location.
- Prior Authorization is not required for advanced imaging services in an emergency room, observation stay, or during an inpatient hospital admission.
- Helps ensure the tests are done in the proper order, eliminate unnecessary tests and decrease the risk of overexposure to radiation. Studies have shown that overexposure to radiation can have negative affects on your health.
- Helps lower your overall medical costs and maximizes your coverage within your benefits.
Please refer to your policy for a complete description of benefits and exclusions.
- Florida Blue or its delegate will review the request and an approval or denial letter will be mailed to you. Please keep this letter for your records.
- With an approval, service is covered at your cost share amount and approved location.
- If there is a denial or no approval, the service is not covered and you may be responsible for the entire cost or a benefit penalty may be applied.
- If the request is not approved, you can talk to your doctor about treatment options. You also have the right to appeal the decision. To download the appeal form, click on the following links (these can be found on the Member Forms page):