The “allowed amount” is the total amount Radia is expected to receive for a given procedure. These amounts are negotiated between Radia and your insurance company.
Co-insurance is a feature of some insurance plans that determines how much responsibility a patient has for a remaining bill after the annual deductible has been satisfied. If you have no co-insurance on your plan, your insurance company pays for 100% of the remaining amount. If you have 20% co-insurance (for example) you are responsible for 20% of the remaining amount and your insurance company is responsible for 80%.
See: Allowed Amount
CPT codes are the way we identify a specific radiologic exam for billing purposes. Your insurance company representative may ask for the CPT code of the exam your provider has ordered so he/she can identify the allowed amount for that exam. If you don't know the CPT code for your exam, please give one of our imaging centers a call! We'd be happy to help.
An annual deductible is the amount the insurance plan-holder must pay out-of-pocket in a calendar year before insurance starts to help out. If you have a $500 deductible, you are responsible for paying $500 towards your medical expenses before your insurance plan benefits kick in.
Diagnosis codes are the codes your care provider uses to tell your insurance company and your imaging provider what they are looking for in an exam. The insurance companies use this code by comparing it to the CPT code of the exam being ordered to make sure the right exam has been ordered.
Global billing is the practice of combining bills for two separate services so the patient is only required to pay one bill. Radia uses global billing in its outpatient imaging centers. Every time you visit a Radia outpatient center, two services are being performed: One service is the exam itself and one service is the radiologist sitting down to read and interpret the images created by the machine during your exam. Because Radia, Inc., P.S. (our group of radiologists) works so closely with our outpatient centers, we are able to bill both services together.
The list charge is how much Radia charges for a particular exam before any discounts are applied. For insurance companies, it's the most Radia would ever ask an insurance company to cover for an exam (typically the amount is negotiated lower - see "allowed amount"). For uninsured patients, it's the most an exam would cost if you paid it all out-of-pocket, and did not qualify for additional discounts.
Out-of-pocket cost is the amount a patient will owe a provider for their services after all discounts, deductibles, co-insurance and other factors have been applied. A patient's out-of-pocket cost is highly dependent on the individual's insurance plan. We encourage all patients to call their insurance plan when trying to determine the out-of-pocket cost for a specific exam.
Some insurance companies or plans require prior authorization before a patient is able to have an imaging exam. This means that the insurance company may require chart notes from your doctor to ensure that the exam being ordered is necessary. In most cases, representatives from the facility where your exam will be performed will work with your referring doctor to get the insurance company the information it needs to make its determination.
If your insurance company requires authorization, but decides not to grant it for your exam (denies coverage), the insurance company will typically not pay for the cost of the exam, even if your deductible has been met. We encourage all patients to find out from their insurance company whether the exam they need is covered, and whether an authorization is required ahead of time.
A tax ID number is the identifying number given to an organization (or in some cases, a person) for tax purposes. Regarding insurance, it is the number used to identify an organization as a unique billing entity. Radia as a whole has three unique billing identities - Our two imaging centers: Evergreen Radia Imaging Center and Swedish Radia Imaging Center at Edmonds, and our group of radiologists, Radia Inc., PS.