Procedure for Obtaining Prior Authorization from Insurance Carriers Prior to Diagnostic Testing
Middlebury College students are expected to carry personal health insurance. Types of insurance plans, coverage limits and requirements vary widely. Many plans require preauthorization for diagnostic testing, particularly with MRIs or CT scans. Porter Hospital often requires preauthorization prior to performing such tests to ensure that they will be paid by the insurance carrier. Without prior authorization, insurance companies will often times refuse payment to the hospital and the individual will then be responsible for full payment.
With the exception of life threatening emergencies, it is up to the patient to obtain prior authorization from their insurance carrier. Middlebury College will assist by faxing provider’s notes and documentation when requested. The College Physician will not telephone insurance carriers, as in our experience this does not expedite the process, takes a considerable amount of time, and typically results in the insurer ultimately requesting that the provider’s notes and documentation be faxed to them.
While this may cause a delay in diagnostic testing and diagnosis and treatment, please understand that it is your insurance carrier imposing this requirement and not the practice of Porter Hospital or Middlebury College.
Steps for Students To Take:
1. Contact your insurance carrier to determine if preauthorization is required for the specific tests that are being requested.
2. Your insurer may want to know:
a. The tests that are being ordered (i.e. MRI, non-contrast, right knee)
b. The diagnosis and the reason for test (meniscus tear)
c. The name of the provider ordering the test
d. The facility where the test is going to be performed
i. Porter Hospital, Middlebury Vermont
ii. Contact the Parton Health Center at 802-443-5135 if your insurer is requesting a National Provider Identification (NPI) number for Porter Hospital or the ordering provider.
3. If preauthorization is required, provide us with the insurer’s fax number. Middlebury College Health Services will do it’s best to expedite the exchange of information.
4. Request your carrier to expedite the process and get the name and telephone number of the person that you’re speaking with.
It is up to the patient to follow-up with their insurance carrier with respect to expediting this process. Once the authorization is received we will order the tests through Porter Hospital.