Understanding Your Health Insurance

March 13, 2024
|| Tags: CT Scan, Global Bill, In-Network, Insurance, MRI, Out-of-Network, Pricing, Prior Authorization

When you’re concerned about your health or the health of a loved one, your focus is on getting the answers you need. The last thing you want to worry about is the ins and outs of health insurance. Advanced Imaging Center has on-staff insurance specialists whose job is to guarantee your insurance questions are answered before you undergo any procedure.

Here are some frequently asked questions our other insurance specialists often field from patients:

What Does it Mean to be In-Network or Out-Of-Network?

In simple terms, in-network refers to a hospital, clinic, or provider that has a contract with your insurance carrier to provide services at a discounted rate. Using an in-network provider typically provides you more benefits, including a lower co-pay, deductible, or other out-of-pocket costs.

Out-of-network means the hospital or clinic or provider you are seeing does not contract with your insurance company for a discounted rate. You can still get care from an out-of-network provider, but it typically means higher out-of-pocket costs for you than if you are receiving care or services from an in-network provider.

If you have a question as to whether a specific hospital, clinic, or provider is in-network, call your insurance provider or refer to their website. Remember, it is always your choice where you get your care.

Ascend Imaging Center accepts most major insurance plans, including auto accidents, workers’ compensation, and government-funded programs. In most cases, we are an in-network provider, but please refer to your health plan information, or call ahead to confirm your coverage and if you need to receive prior authorization.

What Does Prior Authorization Mean?

Prior authorization is a requirement from your health insurance company that your provider obtain approval from your plan before it will cover the costs of a specific medicine, medical device, or procedure. Many insurance companies require some kind of prior authorization for medical imaging exams such as an MRI or CT scan. Our insurance specialists will work with your insurance company directly to obtain prior authorization for your procedure.

Can I Get An Estimate in Advance?

If you want to know the cost of an MRI, CT, or other procedure before your appointment, call us and ask for an insurance specialist. We are happy to provide a personalized price estimate based on your coverage. You will need the name of your referring provider, the type of exam, and your insurance information. Ascend Imaging believes in transparent pricing. You can see the cost for most of our procedures here.

There are a number of factors that go into providing an estimate. To make sure we provide the most accurate price, we need to know whether your exam requires contrast or not. Other factors, such as your insurance deductible and out-of-pocket maximums, can also impact the final cost of your exam.

If you are comparing costs with other imaging centers, be sure to ask if you will receive one global bill or two separate bills. For imaging exams, there are two fees: a technical fee for the imaging itself as well as a professional fee for the radiologist to review your images and write a report for the referring doctor on the findings. It is important to ask what charges make up your estimate and whether it includes both fees.

For more information, contact Ascend Imaging Center’s insurance specialists at (248) 595-8404.

Tagged CT Scan, Global Bill, In-Network, Insurance, MRI, Out-of-Network, Pricing, Prior Authorization