Online Imaging order from radiologist that isn’t my primary


Blue Shield California HMO insurance – Optum Health as medical group. I live in Los Angeles County.

I got a CT scan order from a telehealth appointment from a doctor that isn’t my primary. I contacted Optum and their online reps are saying that it would be covered. I have a gut feeling that they might just be talking out of their butt and not looking into my specific plan and I’ll end up with a big bill so wanted to get another perspective here. Do you think I can schedule the CT scan appointment and it would be covered by my insurance? I read about pre authorizations and how sometimes they’re needed on an imaging lab site, but it was all so confusing to me and I couldn’t find anything in my insurance plan documentation.

Optional reading:

The reason I had to go the telehealth route is because it takes 3 months to get an appointment with the actual doctor at my primary office. The Physician assistant is usually the one that tends to me and he is not the most accommodating. That is usually fine because I don’t get bad ailments, but I recently developed flank pain and my urine apparently has nonvisible blood in it. I think I have kidney stones. The PA ordered an ultrasound, but the results didn’t show anyting and the radiologist said it was a nonremarkable ultrasound. I got a referral for a urologist from the PA, but he won’t be able to see me until December. I tried asking him to order a relevant CT scan since I read that ultrasounds aren’t the most accurate at detecting them (or so I’ve researched), but he said no and the urologist would order one if he thought it was necessary. I pleaded with him that that would mean I would have to wait another 2 months after the Urologist orders it for him to diagnose whatever I have, but he wouldn’t budge. I spoke to a different Urologist and they said the CT would be the next thing that he would order so that’s why I went online. I found a service that can get you a CT with a lab for ~$300, but I would much rather use the imaging order through my insurance and only have to pay the $50 copay.

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