Pre-Authorization: What Patients and Providers Should Know    

The process of pre-authorization (also known as prior authorization, authorization, certification, or precertification) requires approval from the patient’s insurance plan before a service (e.g., imaging) will be paid for. The pre-authorization process at Weill Cornell Imaging at NewYork-Presbyterian plays a critical role in ensuring smooth and efficient access to care for our patients.   

Scheduling and Pre-Authorization Initiation:  

Exams such as Magnetic Resonance Imaging (MRI), Cat Scans (CT) and PET frequently require pre-authorization. The pre-authorization process begins when a patient is scheduled for a procedure or service at one of our Weill Cornell Imaging at NewYork-Presbyterian locations. Once an exam is scheduled, our team collects all necessary information from the patient, their provider, and their insurance plan to determine if pre-authorization is required. 

Submission of Authorization Claim:  

Once our Insurance & Financial Clearance team confirms that a pre-authorization is needed, they work closely with the referring provider’s office. Our team continues to follow up on the authorization status daily, communicating with the insurance carrier for an update regarding the authorization status. 

Communication with Patients:  

We understand the importance of keeping our patients informed throughout the pre-authorization process. If their authorization is not approved the day prior to their scheduled exam, we will call the patient and recommend that the exam is rescheduled to allow for the additional time needed to obtain authorization. Our team will not notify approved patients. In this case, no news is good news.  

It is important to note that the insurance companies may not cover at 100% even with an approved authorization on file. Reasons for this include copay, coinsurance, deductibles, and out of pocket costs. It is essential to review your insurance policy to understand your coverage and potential out-of-pocket costs for radiology services. We are here to answer any questions you may have.  

Impact on Quality of Care:  

By working with our patients and providers to obtain pre-authorization, we ensure that patients receive access to the imaging they need without unexpected delays or financial burdens. Our proactive approach and emphasis on communication helps streamline a patient's journey through our healthcare system, reduces stress, and enhances overall satisfaction with their care experience. 

For insurance-related questions, please reach out to our Insurance and Financial Clearance team at 212-746-6000, option 2. 

For participating insurance plans, please visit: https://wcinyp.org/patients/insurance-and-billing