Can a member be billed if authorization is not obtained?

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No, unless he or she signs a waiver of liability before the test is performed. If authorization and a waiver are not obtained, the liability will fall on the radiologist who rendered the service and the claim will deny provider liability.

If an authorization is denied or has not been obtained, the provider office can create a waiver of liability that specifically states that the authorization has not been obtained or has been denied. If the member still wants to have the test done, the member can sign the waiver stating that he or she knows he or she will be billed for the service. A BCBSRI member who receives non-emergent studies out of area without an authorization may also be held liable.

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