Getting an MRI starts with a doctor’s order. You can’t walk into an imaging center and request one yourself. A physician, physician assistant, or nurse practitioner needs to determine that an MRI is the right diagnostic tool for your situation, then write a referral. From there, the process involves insurance approval, scheduling, preparation, and the scan itself. Here’s what each step looks like.
Getting a Referral
Your primary care doctor or a specialist will order the MRI based on your symptoms, physical exam, or results from other tests. MRIs are commonly ordered for joint injuries, back pain, neurological symptoms like persistent headaches or numbness, and suspected tumors or soft tissue problems. In many cases, your doctor will try simpler imaging first, like an X-ray, before moving to an MRI. This isn’t just protocol; insurers often require evidence that less expensive options were tried first.
If you believe you need an MRI and your doctor hasn’t suggested one, ask directly. Explain what symptoms concern you and why. Doctors are more likely to order one when you can describe specific, persistent problems that haven’t responded to initial treatment.
Insurance Approval and Prior Authorization
Most insurance plans require prior authorization before covering an MRI. This means your doctor’s office submits a request to your insurer explaining why the scan is medically necessary. They may need to include documentation of other treatments you’ve tried, such as physical therapy or medications that didn’t resolve your symptoms.
Your doctor’s office handles this paperwork, not you. But the timeline matters: standard requests can take up to 30 days for a decision. If your doctor considers the situation urgent, they can file an expedited request, which gets a response within 72 business hours. About one-quarter of prior authorization requests are denied, according to the American Medical Association. If yours is denied, you and your doctor can appeal. Among Medicare Advantage plans, over 80% of initial denials are overturned on appeal, so a denial is not necessarily the final word.
If you’re uninsured or paying out of pocket, you can skip this step entirely and schedule directly with an imaging center.
Where You Get the Scan Affects the Price
MRIs are performed at hospitals, outpatient imaging centers, and freestanding radiology facilities. The equipment is often identical, but the price is not. Hospital outpatient departments charge significantly more than independent imaging centers for the same scan. Research from the National Institute for Health Care Reform found that the average price of a knee MRI was about $920 at a hospital outpatient department compared to roughly $600 at a freestanding center, a difference of 52%. That gap applies broadly across MRI types.
If you’re paying out of pocket or have a high deductible, call around. Many imaging centers post cash-pay prices or will quote you a price over the phone. Even with insurance, the facility you choose can significantly affect your copay or coinsurance amount.
Safety Screening Before the Scan
An MRI uses a powerful magnet, not radiation. That magnet can attract certain metals with sudden, dangerous force. Before your scan, you’ll fill out a safety questionnaire about any metal in or on your body. This is the most important part of your preparation.
Items that can create serious problems include:
- Cardiac pacemakers or defibrillators
- Aneurysm clips used to prevent blood vessel bleeding
- Cochlear implants
- Neurostimulation devices
- Implanted medication pumps for insulin, pain management, or chemotherapy
- Metal fragments near the eyes, particularly common in metalworkers
- Bullets or shrapnel
Some newer versions of pacemakers, cochlear implants, and neurostimulators are MRI-compatible, but the technologist needs to know the exact model to follow specific safety protocols. If you have any implant, bring documentation of the device name and manufacturer. Joint replacements made of titanium are generally safe. If there’s any question about a ferromagnetic implant, the scan may be canceled.
Contrast Dye: When It’s Needed
More than a third of MRI exams use a contrast agent injected through an IV to make certain tissues, blood vessels, or abnormalities easier to see. The contrast used in MRI is gadolinium-based, which is different from the iodine-based dye used in CT scans.
Gadolinium is well tolerated by most people, but it carries a small risk for patients with significantly reduced kidney function. Before receiving contrast, your doctor may check your kidney function with a blood test. Patients with severely impaired kidney function (or those on dialysis) face a rare but serious condition where gadolinium causes skin and organ tissue to harden. For people with moderate kidney issues, the risk is much lower, and your care team will weigh the benefit of a clearer image against that risk. If you know you have kidney problems, mention it early in the scheduling process.
What to Expect During the Scan
You’ll change into a hospital gown and remove all jewelry, watches, hair clips, and anything with metal. The technologist will position you on a padded table that slides into the scanner, which looks like a large tube. Most scans take 30 to 60 minutes, depending on the body part being imaged. You need to stay very still; movement blurs the images.
The machine is loud. You’ll hear rhythmic banging, buzzing, and clicking sounds throughout the scan. You’ll be given earplugs or headphones, and many facilities let you listen to music. The technologist communicates with you through a speaker inside the machine and can see you at all times. You’ll have a squeeze ball or button to signal if you need to stop.
If your scan requires contrast, the IV will be placed before or partway through the exam. You may feel a cool sensation when the contrast is injected. The technologist will take additional images after the contrast circulates.
Options for Claustrophobia
The inside of a standard MRI scanner is a narrow tube, and it’s one of the most common reasons people struggle with the exam. If you know you’re claustrophobic, you have several options.
The simplest approach is an open MRI, which has wider openings and less of an enclosed feeling. Image quality on open machines has improved but may not be sufficient for every type of scan. Ask your doctor whether an open MRI would work for your specific needs.
For standard closed MRI machines, mild anxiety can often be managed with an oral anti-anxiety medication taken before the appointment. Your referring doctor can prescribe this. For more significant claustrophobia, IV sedation is available. You’ll be in a relaxed, drowsy state but not fully unconscious. A nurse will place the IV, monitor your vital signs, and stay with you throughout. After sedation of any kind, you will not be allowed to drive, return to work, or leave on your own the same day. Plan to have someone with you for the ride home.
Getting Your Results
After the scan, a radiologist reviews your images and writes a report that goes to the doctor who ordered the MRI. Most results are available within a few business days, though urgent cases can be read the same day. Many health systems now release radiology reports through online patient portals, sometimes before your doctor has had a chance to discuss them with you.
If you see your results on a portal and find the language confusing, that’s normal. Radiology reports are written for other doctors and are full of technical terminology. Wait for your follow-up appointment or call your doctor’s office for an explanation. The radiologist’s job is to describe what they see; your doctor’s job is to tell you what it means for your care.