What is an MRI?
According to the Australian Diagnostic Imaging Association (ADIA), an MRI takes between 20 to 45 minutes and uses powerful magnet and radio-frequency pulses to collect information. This information then forms a detailed view of the body’s soft tissues such as muscles, ligaments, brain tissue, discs and blood vessels. Often called the ‘gold standard’ in radiology, MRI delivers very detailed imaging and can provide a more accurate diagnosis of certain diseases and conditions – particularly soft-tissue injuries that might not show up on other imaging services. There is also no radiation involved in this test, unlike an X-ray or CT scan, the ADIA says. During an MRI, the patient is asked to lie on a bed which then travels through the MRI scanner.
Once under way, patients may experience a vibrating or knocking sound – this is the sound of the machine switching between frequencies. These radio waves stimulate the hydrogen atoms in the body and their movement is picked up and interpreted by the machine to produce the images. Once complete, the images will be interpreted by a radiologist – a specialist medical doctor trained to diagnose using imaging.
How much does an MRI cost today?
An MRI can cost consumers up to almost $1,500, depending on the area of the body being scanned and the reason for the scan, the ADIA says. MRIs are free for inpatients in public hospitals, or when bulk-billed at a radiology practice – providing you have a referral from a specialist or GP and your scan is a Medicare-eligible procedure.
For non-bulk billing radiology clinics, the cost of an MRI will depend on what you’re having scanned and whether the service is listed on the Medicare Benefits Scheme (MBS), meaning you’re eligible for a rebate. It’s a good idea to ask your referring doctor or MRI clinic how much the MRI will cost before you attend your appointment, and also clarify with your health insurance provider if you’ll be covered and, if so, how much of the Medicare gap will be paid.
Is an MRI covered by Medicare?
While inpatient MRI services in public hospitals are covered by Medicare, only some radiology practices are able to offer MRI services that attract a Medicare rebate, according to the ADIA. In order to receive a rebate, you must have a referral from a Medicare-approved GP or specialist. Full Medicare-eligible MRI units are able to perform all MRI services listed on the MBS with a Medicare rebate for the patient. Partial Medicare-eligible MRI units are only able to perform some MRI items listed on the MBS.
Among practices that are able to offer a Medicare rebate to MRI patients, some may provide bulk-billing, but this is not the case for all. When bulk-billing isn’t available, you will be required to pay the full amount before claiming a rebate, with an average gap of almost $200, according to the ADIA. It’s important to note there are some procedures that are not included in the MBS and, as such, there are no rebates available. For example, patients aged over 50 can no longer be referred by their GP for a knee MRI. However, specialists can still provide knee referrals when necessary, regardless of their age MBS says.
Medicare-eligible procedures include:
- Brain scan
- Spinal scan
- Knee scan
- Hip scan
- Elbow scan
- Hand & Wrist scan
- Shoulder scan
- Foot scan
- Temporomandibular joint (TMJ) (the joint that connects your lower jaw to your skull)
- Prostate scan
- Breast scan
- Pancreas / Biliary system scan
- Rectum scan
- Limited heart / vessel scan
A full list of Medicare-eligible procedures and the associated fees are available on the Department of Health website.
Is an MRI covered by private health insurance?
According to the ADIA, for MRIs provided to outpatients, government regulations prevent private health funds being allowed to pay a benefit. However, if you’re having an MRI scan while being treated as an inpatient in hospital, then a benefit from your private health insurance may apply if the Medicare rebate hasn’t covered the full amount. This is called a ‘two-way’ claim. It’s a good idea to check with your health insurance provider that your policy covers MRIs before undertaking the procedure.
Compare Health Insurance with Canstar
The table below features a snapshot of hospital and extras policies on Canstar’s database with links to providers’ websites, sorted by Star Rating (highest to lowest) then by provider name (alphabetically). This has been formulated based on a couple aged under 36 years old with no pregnancy cover and living in NSW. Check upfront with your provider and read the PDS to confirm whether any particular policy covers MRIs, and whether it meets your needs, before committing to it.
Cover image source: Gorodenkoff/Shutterstock.com.
Sub edited by Milan Cuk.
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