Magnetic Resonance Imaging Prior Authorizations for Orthopaedic Care Are Negatively Affected by Medicaid Insurance Status

The low denial rate of initial prior authorization requests over 4 years at our institution underscores the questionable utility of the prior authorization process. Our results are consistent with the current literature that has reported higher rates of denials for MRI prior authorization requests of the spine. Although we were not able to quantify the effect of these denials on patient care, the overall time required to process these requests undoubtedly causes delays in patient care. despite no notable difference seen in socioeconomic status, Horizon NJ Health, a major provider of only Medicaid insurance plans at our institution, was associated with a higher likelihood of denial. This suggests that MRI prior authorization requests submitted for Medicaid patients are more likely to be denied and cause an inequitable delay in care due to this process.