title: Pre-authorization processes have no effect on patients undergoing knee MRI in a pediatric setting when evaluated by specialists.
abstract: OBJECTIVE
  Pre-authorization processes are often used by medical insurance companies to reduce costs by managing the utilization of advanced diagnostic imaging, and their impact on patient care is unclear. The purpose of our study is to determine if a pre-authorization process increases the rate of surgically significant abnormal knee MRI and surgical referrals compared with patients referred from pediatric orthopedic specialists who do not undergo a pre-authorization process.
  
  
  METHODS
  A retrospective study was performed; 124 patients were identified who were referred for knee MRI by a pediatric orthopedist. The study population included patients who underwent an insurance pre-authorization process and the control group consisted of those who did not. The results of the MRI and whether they were deemed surgically significant, in addition to surgical referral, were recorded and compared.
  
  
  RESULTS
  The study and control groups showed no statistically significant difference in outcome with regard to surgically significant findings on MRI (p = 0.92) or whether the patient required surgery (p = 0.6).
  
  
  CONCLUSIONS
  In this population, there is no difference in the likelihood of an abnormal knee MRI demonstrating surgically significant findings or referral to surgery in patients who did and those who did not undergo an insurance pre-authorization process when patients are referred from a pediatric orthopedic specialist. The insurance pre-authorization process does not appear to have an impact on patient diagnosis and treatment and may unnecessarily add bureaucracy and costs.
authors.affiliation: Department of Radiology, Texas Children's Hospital, Houston, TX, USA. DPierce2@kaleidahealth.org.
authors.forename: Drew
authors.initials: D
authors.lastname: Pierce
authors.affiliation: Department of Radiology, Texas Children's Hospital, Houston, TX, USA.
authors.forename: J Herman
authors.initials: JH
authors.lastname: Kan
authors.affiliation: Department of Sports Medicine, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: May
authors.affiliation: Department of Radiology, Texas Children's Hospital, Houston, TX, USA.
authors.forename: George S
authors.initials: GS
authors.lastname: Bisset
mesh_terms: D000293:Adolescent; D002648:Child; D003657:Decision Making; D005260:Female; D006801:Humans; D007343:Insurance Carriers; D007348:Insurance, Health; D007718:Knee Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D007719:Knee Joint / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D012017:Referral and Consultation; D012189:Retrospective Studies; D055815:Young Adult
keywords: Diagnostic imaging; Knee; MRI; Orthopedic; Pediatric; Pre-authorization