WHEN MUST A PHYSICIAN REQUEST ADVANCE AUTHORIZATION FOR MEDICAL CARE?
The law requires a physician to request prior authorization for specialist consultations, surgical procedures, physiotherapeutic procedures, X-rays or special diagnostic laboratory tests costing more than $500 until July 10, 2007.
As of July 11, 2007, the special services must cost more than $1,000 before authorization must be requested. However, as of March 13, 2007, insurance carriers are authorized to require claimants to obtain X-rays, CT Scans, MRIs and other diagnostic tests from a provider or facility within the network it has contracted with for such tests. If the insurance carrier has notified the claimant of this requirement, then the claimant must obtain diagnostic tests from a network facility or provider unless it is an emergency or there is no location within a reasonable distance from the claimant.