Insurance Information for Patients
Your radiologist is a member of most network organizations. If you have a question about our participation in your plan, please call our billing office for confirmation. We will file your insurance as a courtesy to you, but the final resolution and payment of the bill is your responsibility. Our relationship is with you, not your insurance company, but our staff will help you ensure that your insurance carrier complies with the terms of your plan. Please be aware that some insurance plans require referrals and pre-authorizations for selected imaging studies. Talk with your primary care physician or ordering physician if you feel your plan requires these steps. You may also consult your employer group health insurance booklet or your company’s human resources department.
Our physicians are participating providers with Medicare and we will file your Medicare claims for you. We accept assignment of benefits on all Medicare claims. Medicare will send payments and an Explanation of Medicare Benefits (EOMB) directly to our office. An EOMB will also be sent to you from Medicare. Medicare will pay 80% of their approved amount. The remaining 20% of the Medicare approved amount and any deductibles are your responsibility. If you have supplementary coverage to Medicare, we will file the necessary claims for that coverage as well. However, if your secondary insurance does not pay the portion left after the Medicare payment, you will be responsible for paying the remaining balance. A billing statement will be sent to you showing the balance payable after the Medicare payment is received.
Medicaid, TennCare, Tricare, Champus, ChampVA nd other federally funded plans
We participate with Champus, Medicaid and certain TennCare providers. Please call our office or your TennCare carrier for confirmation of our participation if you have questions. Our office staff will file Champus, Medicaid and TennCare claim forms. If a balance is due after the plan’s payment is received, you will be sent a billing statement indicating this activity.
Usual, Customary and Reasonable Charges
Many health insurance plans pay using a percentage of Usual, Customary and Reasonable (UCR) charges. Our fees are competitive and generally are within the UCR range for our area. However, some plans pay a set fee from an arbitrary schedule or list of fees for each service. These fees may bear no relationship to the current cost of care. We do not discount fees due to UCR, but our billing staff will assist you if your plan applies a UCR rate that falls below our fees. We can produce documents for your insurance carrier showing the actual cost of care in our area. Should your insurance choose to pay below our fees due to their UCR, the remaining balance will be your responsibility. Please consult your employer’s group health insurance booklet, your employer’s personnel department, or your insurance company if you have coverage questions.
Following is a general list of insurance companies in which Radiology Alliance participates. The list is being continuously updated so to verify your coverage or to find out more detailed information, please contact your insurance company directly at the number listed on the back of your insurance member ID card. This list does not guarantee coverage or participation.