Advanced imaging is one of the most heavily prior-authorized services in healthcare, which means MRIs get denied a lot — and usually for one of a handful of fixable reasons.
Two paths get an MRI approved, and which one applies depends on your symptoms:
Same scan, opposite outcome. A request that reads "low back pain, MRI requested" gets denied — premature, no documented conservative care. A request that reads "lumbar radiculopathy, radiating leg pain, eight weeks of failed physical therapy" gets approved. The difference isn't the patient or the scan. It's whether the request said what the insurer's checklist needed to hear.
And if your MRI has already been denied and an internal appeal doesn't fix it, you may have a right to a free, independent external review — the process varies by state. In Texas, for example, here's how to appeal a denied health-insurance claim in Texas.
Answer a few plain questions about your symptoms and treatment so far, and see where you stand against your insurer's real imaging criteria — plus exactly what's missing if you're not there yet.
Check my coverageYes, and MRI denials are frequently overturned — especially when the original request was missing documentation that already existed (like prior physical therapy or an X-ray). Adding the missing detail, or appealing with it, often reverses the denial.
For routine musculoskeletal pain without red-flag symptoms, most pain improves with conservative care, and early imaging often finds incidental things that lead to unnecessary treatment. So insurers require a documented trial first. A red-flag symptom removes that requirement.
Usually yes, but with conditions: a red-flag symptom gets it approved right away; otherwise insurers want documented nerve-related symptoms plus about six weeks of conservative treatment first. New, uncomplicated back pain on its own is typically denied.
For a long-standing, typical headache (migraine or tension-type) with a normal neurological exam, a brain MRI is generally considered not medically necessary. Insurers approve it when there's a red-flag feature — a sudden severe onset, a first headache after age 50, a new neurological deficit, or similar.
The criteria are published, but they're buried in long medical policies. WillItCover translates them into a few plain questions and tells you where you stand — and what to document — before the request is filed.
Related: Why prior authorizations get denied · Advanced imaging