What is the nurse obtaining when calling a client’s insurance company prior to scheduling an MRI test?

When a nurse calls a client's insurance company prior to scheduling an MRI test, they are often obtaining precertification. Precertification, also known as prior authorization, is a process in which the insurance company reviews the necessity of a specific medical procedure or service before it is provided. This step ensures that the insurance will cover the procedure, confirming that it meets the criteria established in the client’s health plan.

The precertification process typically involves providing details about the client's medical history and the necessity of the MRI to ensure it aligns with the insurance company's guidelines. This is crucial because many insurance plans require approval for certain tests to manage costs and prevent unnecessary treatments.

While verification of benefits pertains to confirming the specifics of the client’s insurance coverage, such as what services are included under their plan or if there are copayments, it does not guarantee that the MRI itself is authorized for payment. Authorization and precertification are closely related terms, but they specifically indicate the process of obtaining pre-approval from the insurance for that service. A patient referral usually involves a recommendation from one provider to another and does not directly relate to the insurance process for scheduling tests like an MRI.