How to Shop for a Radiology Procedure

How to Shop for a Radiology Procedure

By Jordan Epstein 

I remember the last time I bought a car. I knew I wanted a convertible, so I went from dealer to dealer test driving for important features like trunk space and speed of transformation (yes, I looked at the Camaro first) before settling on a model, and then I checked Kelley Blue Book, called a few dealers, and settled quickly on a fair price.  (For the record I chose a 2014 Ford Mustang. It’s awesome.)

Car

Healthcare is nothing like that. For obvious reasons, test driving isn’t the best idea, and without transparency, it’s hard to identify what model of healthcare providers you want, and even harder to find information about the features affecting their price and quality.

So I thought I’d write you this step-by-step guide through the labyrinth of this one small corner of the healthcare industry to help you find the care that’s right for you. Here we go.

1. Find your CPT code

Barcode man

So your doctor says you need imaging. Don’t panic–calmly look at the order form the nice lady at the front desk has handed you. It should say something like “Requisition for Imaging”, and have a description of procedures requested, often with check boxes down the side with the one or two marked for your procedure. What you’re looking for is your procedure’s current procedural terminology (CPT) code. These are specific numbers and letters that identify each procedure. CPT codes are standardized so that no matter which insurance and healthcare provider you use, you have the same CPT code.  If you can’t find it on the form, you can easily learn the CPT code for your procedure by asking your doctor, looking it up online, or using an app like Stroll. Note that location on the body and whether or not the procedure comes with ‘contrast’ all affect the code.

2. Know your insurance network

Spiderweb

If you don’t have insurance, then you can go to any provider and pay the cash rate (but be sure you ask for their discount cash rate first—we’ll have another article out on this topic soon). But if you’re insured, you’ll need to find out whether a provider you’re considering is in-network or out-of-network. Your insurance will pay a larger percentage of in-network care than it will for out-of-network care, and sometimes out-of-network care won’t be covered at all. So if you can, you should choose an in-network provider. Be sure that both the facility (which could be a hospital or an independent center) as well as the radiologist (one of the facility’s doctors who is an expert in medical imaging) are in-network for your insurance plan. You can call the provider to check that both the facility and the radiologist are in-network. Be sure to use the word “in-network” and not “covered,” because some facilities can be deliberately misleading and say that you are “covered” when they are out-of-network, because your plan includes both in-network and out-of-network benefit. If a facility can’t or won’t answer the question of whether they and their radiologists are in-network for you, go somewhere else.

Some of you, especially those insured directly by hospitals or academic medical centers, might have a multi-tiered plan. Multi-tiered plans usually have ‘Gold’ or ‘Preferred’ in-network providers, which often have little to no cost-sharing for you as a patient. It’s important to know and seek out those top-tier providers–call your insurance company or your company’s health administrator.

If you’re based on the exchange, you might see a benefit that distinguishes between ‘freestanding’ and ‘outpatient hospital’ centers. Unfortunately, neither your insurance, that center, or anyone else actually knows what type of center your insurance will definitively assign to which category, but you can take a guess and google the imaging center. If it seems to be affiliated with a hospital or medical group that sounds familiar and does more than just imaging, it’s probably not freestanding.

3. Understand your radiology benefit

Wallets
If you’re insured, your imaging benefits will determine how much you end up paying out-of-pocket. Some imaging benefits require just a copay, or a flat rate regardless of what the insurance company ends up paying. Others require a coinsurance, in which case you have to pay the full amount of the final price up to your deductible, at which point you and your insurance split the difference based on your coinsurance. Deductibles can vary from nothing to several thousand dollars, and often for high-deductible plans, you personally—not your insurance company—will be responsible for paying the full price. You can confirm your current deductible status by calling your insurance company or logging onto their website. Check on your imaging benefits by looking for a document called “Summary of Benefits” and searching for the right benefit for your procedure, usually ‘MRI/CT’, ‘Mammogram’, ‘General Diagnostic’, or ‘Xray’.

4. Estimate cost of care

Abacus

When you’ve found some providers that seem promising, you have a few ways to research cost. One is to call the provider and ask about their cash price for your CPT code. Be aware that while providers may be able to tell you the cash price without insurance, providers negotiate prices with each of their partner insurance companies, and unfortunately they don’t usually share these negotiated prices with patients. You can also do some research on your insurance company’s website, but even within one insurer, individual people’s plans differ, so you might not be able to factor in your own plan’s radiology benefit. Because providers and insurance companies can be difficult to contact and lacking in transparency, Stroll can give you the information you need to find the best value care. Stroll offers price quotes for each facility in your area based on your up-to-date insurance information, making cost comparison simple.

Teacups
No matter your insurance, hospitals are usually much more expensive than independent imaging centers, potentially several times more expensive. By charging more for outpatient procedures, hospitals can offset some of their other high costs. Independent imaging centers tend to be much smaller, with lower overhead, so they can offer patients lower prices. Especially if you’re not currently hospitalized, you can find equally high-quality but much more affordable care by choosing an independent facility instead of a hospital.

5. Making the switch

Wax seal

If your doctor just handed you a list of providers and left you to your own devices to find an imaging center, you can just go ahead and the center and ask for an appointment. For most of us, though, your doctor will have referred you to a specific provider. Now you face a quandary. There are many reasonable reasons why your doctor might prefer one location over another, especially when it comes to interoperability (the fancy health care word for the ability of your doctor to be able to easily the results of another’s) and preference for equipment, image type,  and radiologist. You can read more about what matters in quality in radiology, but the point is that you run the risk of ticking off your doctor if you simply make the switch without asking. So I’d recommend calling your doctor’s office, and if you don’t hear a reason that makes you compelled to continue with the center your doctor referred you to, go ahead and make the call.

Prior authorization

If you’re paying with a typical commercial insurance, it’s likely that the center will also need to get “prior authorization” from your insurance company. Prior authorization confirms that your insurance company is aware of where you’re receiving care and believes the care to be medically necessary. Note that you only need prior authorization if you’re insured through an insurance company. If you’re paying independently or with standard Medicare, you don’t need prior authorization.  Make sure that you tell your new imaging center your doctor’s name and phone number, as it’s likely they’ll need to contact your doctor to get your health records.

6. Getting the test

In all cases, be sure to bring your photo ID and original doctor’s order, and insurance card if you have it. Make sure that the center has your doctor’s contact information and that they’ll send your doctor the results of the radiologist read or films if necessary. Unless otherwise instructed by your doctor to pick up the actual film copies of your images, don’t leave the imaging center without a DVD copy of your images.

7. The payoff

At the end of the day, it is possible to find peace of mind and high quality, affordable healthcare. Even if your doctor has made a referral, you can still learn more about your options, talk with your doctor about alternatives, and find the best value center for you–just as you would with a new convertible. Now that you’ve read about shopping for an imaging center, you’re ready to learn what to expect from an MRI. Look forward to reading your thoughts in the comments!

Stroll Health is dedicated to helping you reach quality, in-network, low cost care.

Share

Comments

  1. I do not know if it’s just me or if everybody else experiencing issues with your website.
    It appears as though some of the text on your content are running off the screen. Can somebody else please
    provide feedback and let me know if this is happening to them as well?
    This may be a issue with my web browser because I’ve had this happen before.
    Many thanks

  2. TҺank уoս a bunch fߋr sharing this with аll of
    uѕ you actually know what you are talking аbout! Bookmarked.

    Kindly аlso consult wіtһ mу website =).
    We coսld Һave a link tгade agreement among
    us

  3. No one can do it better than you.

  4. You happen to be so cool! I really do not believe I actually have read just one thing
    such as this before. So good to get somebody
    with a few original ideas on this issue. Really.. thanks a lot
    for starting this up. This site is a thing that is required on the internet, someone with a bit of originality!

  5. Every weekend i accustomed to head to see this web page, because i want enjoyment,
    because this this site conations genuinely fastidious funny stuff too.

  6. What’s up, just wished to mention, I enjoyed this post.
    It was actually practical. Continue posting!

  7. Your comment is awaiting moderation.

    You said that terrifically.

    australian viagra best viagra online
    viagra without a doctors prescription
    india pharmacies generic viagra – https://genericviagramsl.com

    GeraldNal
    Dwaynesex
    Kevinzed

  8. Your comment is awaiting moderation.

    Very good data. Many thanks.

    viagra dosage suhagra lowest price viagra uk
    generic viagra 100mg
    viagra and sports – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  9. Your comment is awaiting moderation.

    Well voiced indeed. !

    mail order and viagra viagra superactive canadian
    viagra without a doctors prescription
    can women take viagra and hormones – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  10. Your comment is awaiting moderation.

    Very well voiced without a doubt. !

    viagra cof forid 11 ectasy and viagra taken together
    buy viagra online
    do women like viagra – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  11. Your comment is awaiting moderation.

    Great facts. Thank you.

    viagra contraindications viagra sildenafil citrate without prescription
    generic viagra
    cialis generic lowest price viagra – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  12. Your comment is awaiting moderation.

    This is nicely said! .

    250mg viagra canadas viagra number online pharmacy
    buy viagra
    get viagra at an online pharmacy – https://genericviagramsl.com

    GeraldNal
    Dwaynesex
    Kevinzed

  13. Your comment is awaiting moderation.

    With thanks, Useful stuff.

    viagra boosts post cuddle chemical pros and cons viagra
    viagra 100mg
    taking viagra – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  14. Your comment is awaiting moderation.

    Position certainly taken!.

    compare generic viagra wholesale prices soft generic viagra
    viagra 100mg
    viagra prescription under nhs – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  15. Your comment is awaiting moderation.

    You stated that very well.

    buy levitra online viagra generic viagra woman
    generic viagra online
    viagra in uk reviews – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  16. Your comment is awaiting moderation.

    Nicely put. Thanks a lot!

    get caught ordering viagra online viagra wiht women
    generic viagra 100mg
    can viagra cause impotence – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  17. Your comment is awaiting moderation.

    You explained that effectively.

    50 cent generic viagra canadas viagra
    viagra pills
    how long viagra lasts – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  18. Your comment is awaiting moderation.

    You actually expressed that adequately!

    tricked into taking viagra most effective ways to use viagra
    generic viagra
    increased anger taking viagra – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  19. Your comment is awaiting moderation.

    You mentioned it wonderfully!

    viagra insurance coverage ods viagra australia information stories
    viagra for women
    woman use viagra – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  20. Your comment is awaiting moderation.

    Thanks. Quite a lot of tips.

    compare viagra to nizagara viagra nebo cialis
    viagra 100mg
    women taking viagra female – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  21. Your comment is awaiting moderation.

    Terrific facts, Kudos!

    viagra no doctor canada viagra idiots
    viagra for women
    valium viagra interaction – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  22. Your comment is awaiting moderation.

    Awesome tips. With thanks!

    viagra save chrismas mexican viagra
    generic viagra 100mg
    viagra viagra pages edinburgh find free – https://genericviagramsl.com

    GeraldNal
    Dwaynesex
    Kevinzed

  23. Your comment is awaiting moderation.

    Awesome stuff. Thanks a lot.

    get viagra prescription now viagra results videos
    generic viagra
    what is the best herbal viagra – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  24. Your comment is awaiting moderation.

    Many thanks. Numerous content!

    how much is viagra viagra for weman
    generic viagra
    viagra cheap online – https://genericviagramsl.com

    GeraldNal
    Dwaynesex
    Kevinzed

  25. Your comment is awaiting moderation.

    Factor clearly considered..

    der kleine nils viagra in mexico viagra
    generic viagra
    find search viagra free – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  26. Your comment is awaiting moderation.

    Thanks. I enjoy it!

    viagra cheap no prescrip what does viagra do viagra
    viagra 100mg
    viagra creme – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  27. Your comment is awaiting moderation.

    You explained this perfectly!

    viagra retail discoun generic viagra for women
    buy generic viagra
    viagra product insert – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  28. Your comment is awaiting moderation.

    Thanks! Valuable information!

    viagra cream for woman viagra information
    viagra for sale uk
    free sex using viagra – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  29. Your comment is awaiting moderation.

    Many thanks, Very good stuff.

    viagra like strips viagra and grapefruit
    viagra pills
    viagra inurl – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  30. Your comment is awaiting moderation.

    Good stuff. Regards!

    viagra super force sale cheap dangers of viagra mayo clinic
    cheap viagra
    off shore viagra – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  31. Your comment is awaiting moderation.

    Appreciate it! Quite a lot of material.

    viagra in the waters karaoke viagra sales from canadian pharmacy
    generic viagra online
    viagra protester – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  32. Your comment is awaiting moderation.

    You actually reported it superbly.

    free sample pack of viagra viagra vs cilalis
    buy generic viagra
    viagra in the uk – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  33. Your comment is awaiting moderation.

    Appreciate it. Loads of content.

    ciao buy now viagra url viagra history wikipedia
    viagra for sale uk
    edinburgh viagra search linskaill charles – https://genericviagramsl.com

    GeraldNal
    Dwaynesex
    Kevinzed

  34. Your comment is awaiting moderation.

    You reported it well!

    amy reid is viagra really needed alternative til viagra
    viagra online
    viagra soft how to take – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  35. Your comment is awaiting moderation.

    You actually stated it really well!

    cialis and viagra spanish viagra
    viagra online
    will viagra work on young males – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  36. Your comment is awaiting moderation.

    You stated it superbly!

    herbal viagra uk viagra massage
    viagra pills
    interaction viagra cialis – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  37. Your comment is awaiting moderation.

    Good postings. Cheers.

    caverta generic viagra generic viagra pillshoprxcom viagra anally in a enema
    generic viagra 100mg
    viagra lolo – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  38. Your comment is awaiting moderation.

    Terrific posts, Thanks!

    viagra ill effects tadalafil beats viagra
    viagra generic
    never take steroids and viagra – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  39. Your comment is awaiting moderation.

    Regards, An abundance of write ups.

    viagra testimonials bali viagra
    viagra for sale uk
    otc for viagra – https://genericviagramsl.com

    GeraldNal
    Dwaynesex
    Kevinzed

  40. Your comment is awaiting moderation.

    Seriously loads of amazing material.

    viagra no prescription in usa modo de empleo viagra
    viagra pills
    viagra generic price iframe – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  41. Your comment is awaiting moderation.

    Seriously plenty of wonderful knowledge!

    viagra official reseller viagra enter email address
    viagra pills
    nitroglycerin and viagra – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  42. Your comment is awaiting moderation.

    This is nicely said. .

    viagra for sale in gibralter cheap viagra soft tabs
    viagra pills
    delaware caverta generic viagra veega – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  43. Your comment is awaiting moderation.

    Kudos, Valuable stuff.

    viagra sites which accept paypal 4 hour hardon viagra
    cheap viagra
    blue order pill viagra – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  44. Your comment is awaiting moderation.

    Appreciate it! Plenty of posts.

    generic viagra louisville ky herbal viagra in stores
    cheap viagra
    viagra ship to canada paypal – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  45. Your comment is awaiting moderation.

    Good write ups, Cheers!

    cheapest online viagra canada drugstores americans viagra border
    viagra online
    medical articles on viagra – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  46. Your comment is awaiting moderation.

    You made your stand extremely nicely!.

    personalized viagra gifts viagra siesta
    viagra for women
    viagra cheap price – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  47. Your comment is awaiting moderation.

    Many thanks, An abundance of content!

    buy viagra inte taking viagra recovery time
    viagra for women
    viagra tutorial – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  48. Your comment is awaiting moderation.

    Amazing write ups, With thanks.

    naked men on viagra buy cheap viagra prescription online
    cheap viagra
    viagra ed meds 30 off – https://genericviagramsl.com

    GeraldNal
    Dwaynesex
    Kevinzed

  49. Your comment is awaiting moderation.

    Valuable tips. Thank you.

    viagra and eating a meal viagra shop uk
    generic viagra online
    viagra recreational – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  50. Your comment is awaiting moderation.

    Many thanks. I enjoy it.

    viagra didn’t work viagra stories blogs
    generic viagra online
    can woman take viagra – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  51. Your comment is awaiting moderation.

    You definitely made the point.

    anal use of viagra recommended viagra dosage
    viagra pills
    how to buy viagra on line – https://genericviagramsl.com

    GeraldNal
    Dwaynesex
    Kevinzed

  52. Your comment is awaiting moderation.

    With thanks, Excellent stuff!

    discount viagra sales online viagra brand names
    generic viagra 100mg
    viagra side effects and blog – https://genericviagrantx.com

    GeraldNal
    Dwaynesex
    Kevinzed

  53. Your comment is awaiting moderation.

    You made the point!

    unnecessary viagra use viagra medicamentos similares
    generic viagra online
    results of cialis and viagra – https://genericviagramsl.com

    GeraldNal
    Dwaynesex
    Kevinzed

  54. Your comment is awaiting moderation.

    Regards. Terrific information!

    search viagra viagra edinburgh pages online what’s in viagra
    viagra without a doctors prescription
    content in viagra – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

  55. Your comment is awaiting moderation.

    Kudos. Great information.

    pornstars viagra flushing prices viagra
    viagra for women
    generic viagra from china – https://genericviagrarcp.com

    GeraldNal
    Dwaynesex
    Kevinzed

Leave a Reply

Your email address will not be published. Required fields are marked *

Making healthcare as easy as a Stroll