Imaging/RX orders from out of network provider
I have an Anthem Healthkeepers HMO from the Virginia marketplace. The closest in network rheumatologists to me (still 2+ hours away) have waitlists until the end of year/beginning of next year so I found a direct care rheumatologist out of state I can see sooner. I know that I will not be able to get reimbursed for the self pay visits and am ok with that but don't know how labs/imaging orders will work.
If the out of network provider sends orders for, say x-rays or an MRI to a local in network facility will the procedure be covered as long as the imaging facility secures prior authorization? Or will it be denied because the ordering provider is out of network?
For prescriptions I know that if they are sent to an in-network pharmacy they should be covered but what about specialty prescriptions or ones that require step therapy/prior authorization? Will I be able to submit prior authorization myself for those medications or will I be out of luck using insurance for them?
Posted Feb 19, 2026, 3:14 PM UTC