Getting a brain MRI starts with a referral from a healthcare provider who documents a medical reason for the scan. You can’t typically walk into an imaging center and order one yourself. The process involves a doctor’s order, possible insurance authorization, a safety screening, and then the scan itself, which takes 30 to 60 minutes. Here’s what each step looks like in practice.
Getting a Doctor’s Order
A brain MRI requires an order from a physician or qualified nonphysician practitioner such as a nurse practitioner or physician assistant. Your primary care doctor can order one, as can neurologists, emergency physicians, and other specialists. The key requirement is medical necessity: your provider needs to document symptoms or clinical findings that justify the scan.
Common reasons providers order brain MRIs include persistent or severe headaches, dizziness, seizures, vision changes, hearing loss, difficulty moving part of your body, or suspected conditions like stroke, brain tumors, or multiple sclerosis. If you’re experiencing symptoms you think warrant a scan, bring them up with your doctor. Be specific about what you’re feeling, when it started, and how it’s changed. That clinical history is what supports the order.
Without documented medical necessity, insurance will deny the claim. Your provider’s notes need to include relevant signs, symptoms, or abnormal findings. If your doctor doesn’t think an MRI is warranted, you can ask for a referral to a neurologist for a second opinion, or in some cases pay out of pocket at an independent imaging center, though this is expensive.
Insurance Approval and Prior Authorization
Many insurance plans require prior authorization before they’ll cover a brain MRI. This means your doctor’s office submits a request to your insurer explaining why the scan is needed, and the insurer reviews it before giving the green light. Your doctor’s office handles this process, not you, but it helps to follow up and confirm it’s been submitted.
Standard authorization reviews can take up to 30 days. If your doctor considers the situation urgent, they can submit an expedited request, which gets a response within 72 business hours. Once approved, you’ll receive confirmation of coverage and can schedule the scan. If authorization is denied, your doctor can appeal with additional documentation.
Where You Get the Scan Matters for Cost
You’ll typically choose between a hospital outpatient department and a freestanding imaging center. The difference in price is significant. Research from the Employee Benefit Research Institute found that MRI services at hospital outpatient departments cost roughly $1,100 on average, while the same scans at independent physician offices or imaging centers came in under $600. That’s about 90% more at the hospital for the same test.
If your insurance gives you a choice of location, an independent outpatient imaging center will almost always cost less, both for your insurer and for your out-of-pocket share. Call your insurance company to ask which facilities are in-network and compare your copay or coinsurance at each. For those paying out of pocket entirely, freestanding centers often offer cash-pay rates that are a fraction of hospital pricing.
The Safety Screening
Before your scan, you’ll complete a safety questionnaire about metal in or on your body. MRI machines use extremely powerful magnets, and certain metallic implants or devices are dangerous inside the scanner. Pacemakers, implantable defibrillators, and certain types of pacing wires are absolute contraindications, meaning the scan cannot be performed. Coronary stents and some other implants may be safe depending on the specific device and how long ago it was placed, but they require careful review.
You’ll also be asked about metal fragments from injuries or occupational exposure (welding, metalwork), surgical clips, cochlear implants, and any other implanted devices. Remove all jewelry, piercings, hair clips, and clothing with metal fasteners before the scan. If you have any implant and aren’t sure whether it’s MRI-safe, gather the details (manufacturer, model number, implant card) before your appointment so the imaging team can verify compatibility.
With or Without Contrast
Your doctor may order the MRI with contrast, without contrast, or both. Contrast involves an injection of a gadolinium-based agent into a vein partway through the scan. It makes certain structures and abnormalities, particularly tumors, infections, and inflammation, show up more clearly.
For most people with normal kidney function, gadolinium contrast is safe. The primary risk is for patients with severe kidney disease (specifically, those whose kidneys filter at less than 30% of normal capacity). In these patients, gadolinium can trigger a rare but serious condition called nephrogenic systemic fibrosis, which causes hardening and tightening of the skin and can affect internal organs. If you’re over 60, have diabetes, or have high blood pressure, your doctor may order a blood test to check your kidney function before approving contrast. If your kidneys are healthy, this isn’t a concern.
Minor side effects from the injection, like a brief cool sensation or mild nausea, are common and pass quickly. Allergic reactions are rare but possible. Let the technologist know if you’ve had a reaction to contrast in the past.
What the Scan Is Like
A brain MRI typically lasts 30 to 60 minutes, sometimes longer if contrast is used or if multiple sequences are needed. You’ll lie on a padded table that slides into a tube-shaped scanner. A coil (a cage-like frame) is placed over your head to help capture the images. The machine makes loud knocking, buzzing, and clicking sounds throughout the scan. You’ll be given earplugs or headphones.
The most important thing you need to do is hold still. Even small movements blur the images and may require repeating sequences, which extends the scan time. You’ll be able to communicate with the technologist through an intercom, and you’ll have a squeeze ball or button to signal if you need to stop.
Managing Claustrophobia
The bore of a standard closed MRI scanner is narrow, and many people feel anxious inside it. If you know you’re claustrophobic, tell your doctor when the scan is ordered, not on the day of the appointment. Several options exist depending on severity.
For mild anxiety, simple strategies like closing your eyes before entering the scanner, using the headphones to listen to music, and practicing slow breathing are often enough. For moderate anxiety, your doctor can prescribe a mild oral sedative to take before the appointment. You’ll need someone to drive you home afterward. Deep sedation or general anesthesia is rarely needed for adults and is typically reserved for patients with severe psychiatric conditions or uncontrollable agitation. Children between ages 1 and 6 often require deeper sedation because they can’t stay still long enough.
Open MRI machines are an alternative for patients who can’t tolerate the enclosed tube. These scanners have open sides, which reduces the feeling of confinement. The tradeoff is image quality: open MRI magnets operate at 0.2 to 0.3 Tesla, compared to 1.0 to 3.0 Tesla in standard closed scanners. That lower magnetic field strength produces lower-resolution images, and in some cases the scan may need to be repeated on a closed scanner for an accurate diagnosis. For brain imaging, where fine detail matters, this is worth discussing with your doctor before choosing an open scanner.
Getting Your Results
After your scan, a radiologist reviews the images and writes a report that goes to the doctor who ordered the MRI. How quickly this happens varies by facility, priority level, and what the scan shows. If the radiologist spots a critical finding, like evidence of a stroke or a large mass, they’re required to contact your ordering provider promptly, often the same day.
For routine, non-urgent scans, results typically reach your doctor within a few business days. Many health systems now post imaging reports to online patient portals, sometimes before your doctor has had a chance to review them. If you read your report and see unfamiliar terms, wait to discuss the findings with your doctor, who can explain what the results mean for your specific situation and whether any follow-up imaging or treatment is needed.