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I made an appointment for a calcium scan at a local branch of a firm specializing in X-Rays, CAT-scans and the likes. I knew, the procedure is not covered by insurance (don't know, why) -- and the lady making the appointment reminded me of that again.

Yet, when I came at the scheduled time, they asked for a doctor's prescription for the exam -- claiming, that they "cannot perform it" without such a prescription. When I asked, if this inability is due to their own firm's policy, or an actual law, they said -- after some hesitation -- that it is the latter. That no exam can be performed without a doctor's request for same.

But no one in the office was able to cite the actual law, which makes me doubtful...

So here I am asking the question: is it really illegal for an X-Ray provider, for example, to take a shot of (or through) your hand without a doctor prescribing it first?

Or is it simply the corporation's own policy -- created up above to avoid problems with insurance companies, who might refuse to pay for non-prescribed exams, and then applied down below (foolishly) even to the procedures, that are not covered by any insurance to begin with?

It makes no sense to me, that I can go to a barber for a shave -- which, with the sharp blade next to major blood vessels is much more dangerous, than a CAT-scan -- whenever I want, but must pay hundreds of dollars for a cardiologist to prescribe a heart-scan, before I can have one performed...

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    Maybe referral, not prescription?
    – littleadv
    Commented yesterday
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    The problem with radiological scans is that damage caused by ionizing radiation accumulates. It doesn't matter if you've been to the barber 1000 times, your next shave is no more risky than the last one. If someone could sign themselves up for unlimited CT scans without any oversight, they could wind up getting several lifetimes' worth of radiation, with each additional scan posing higher risk than the last one. The medical benefit of a scan doesn't always outweigh the risks and requires oversight, but the risk/reward of a shave doesn't require an MD to determine it's a net benefit.
    – Nuclear Hoagie
    Commented yesterday
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    If you've already seen the cardiologist or have an upcoming visit, you may be able to contact the office/nurse and ask if the cardiologist can place the order for the scan without a visit.
    – mkennedy
    Commented yesterday
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    "is much more dangerous, than a CAT-scan" A CAT scan has an estimated risk of causing cancer of around 1 in 2000. It is dangerous.
    – user71659
    Commented yesterday
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    AFAIK, in The Netherlands, non-prescribed preventive exams are prohibited by law because they take scarce resources and lead to false positives, which take up yet more scarce resources (and possibly insured costs).
    – gerrit
    Commented yesterday

1 Answer 1

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A "prescription" is an alternative term for a "physician's order" or "physician referral". A CAT scan is a type of radiological service.

New Jersey Administrative Code § 10:54-4.21 includes this paragraph:

(i) No radiological services shall be provided in the outpatient hospital setting without the referral of a physician or other licensed medical practitioner, acting within his or her scope of practice.

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    Thank you! I wonder, if NY has a similar law... I really hate to pay the cardiologist for two visits.
    – Mikhail T.
    Commented yesterday
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    @MikhailT. To the best of my knowledge, the only radiology exception in NY is for screening mammograms, no physician order required. CAT scans of any kind are almost certainly restricted because of the high radiation dose. Physicians are supposed to review the patient's medical record for other radiation exposure before ordering a CAT scan. NY also allows medical tests by a lab without a prescription if any over-the-counter, at-home test for the same condition or substance has been approved by the FDA.
    – MTA
    Commented yesterday
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    If this is just a case of the cardiologist having forgotten to issue said referral, a call to the office will probably suffice, that's just an admin problem.
    – Marianne013
    Commented 21 hours ago
  • NY also allows medical tests by a lab without a prescription if any over-the-counter, at-home test for the same condition or substance has been approved by the FDA. So someone (not sure who actually want to do such a thing) could get a colonoscopy without a referral because it is a screen for colon cancer and so is Cologuard?
    – manassehkatz-Moving 2 Codidact
    Commented 17 hours ago
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    @manassehkatz-Moving2Codidact Nah, a colonoscopy is a procedure, and you can't go to lab like Quest Diagnostics to get one. I think the goal of the NY law is that a person who does an OTC at-home test can have it repeated by a lab (without a doctor's order) for confirmation of the results if they have any doubts about accuracy.
    – MTA
    Commented 16 hours ago

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