What to Know About Your Insurance Coverage Before Your Procedure

At Iowa Radiology, we strive to make sure you understand all aspects of the care we provide.  Insurance is an element of heath care that can be exceedingly complex and baffling to many of us. Understanding the following things about your coverage before scheduling your procedure can help you understand what costs to expect and how to keep them to a minimum.

1.  Know what facilities are within your insurance network.  Using out-of-network providers will cost you more out of pocket than choosing an in-network facility.

2. The Affordable Care act lists screening mammography as a required preventive health service.  Most (though not all) carriers, including all health plans offered through the healthcare.gov Marketplace, apply no copay, coinsurance, or deductible to screening mammograms.  To be certain about your specific coverage, it is always best to check with your insurance carrier. Again, you will need to use an in-network provider for services.  Going out of your network always runs the risk of increasing your costs.

3. Diagnostic mammography is distinct from screening mammography.  While screening mammograms are performed on patients who have no symptoms, diagnostic mammograms and breast ultrasound or breast MRI may be ordered based on specific concerns raised by the patient or her physician or as follow-up to abnormal findings on a screening mammogram.  Because of its different nature, diagnostic mammography is billed separately and processed differently by insurance companies than screening mammography. Often, because it is a medical rather than a preventive or routine benefit, copayments and deductibles will apply to a diagnostic mammogram.

4. Understand the different levels of coverage your insurer offers for different places of service. Often, services performed in an office setting result in lower patient costs than those performed in an outpatient department or facility.  Call your insurance provider before scheduling your procedure. It will help to know the following information:

• The place of service code used by your facility of choice
• Whether the provider participates in your insurance network
• Under what specialty your service will be billed (especially helpful if undergoing MRI or CT scan)

Iowa Radiology bills under place of service code 11, which indicates an office setting, and the specialty diagnostic radiology.

5. If you participate in a health savings account (HSA), it is helpful to call and ask about any fees you will incur for services and prescriptions you may require, since you will be paying for non-preventive services out of pocket until your deductible is met.

6. Understand the basics of your health plan.  Know your deductibles, copayments or coinsurance, your out-of-pocket maximum, and differences in coverage for specialty care.

Feel free to call our billing office at 515-226-2122 with questions about insurance coverage for services at any of our locations in Des Moines, Ankeny, Clive, or Lakeview.

The information contained in the Iowa Radiology website is presented as public service information only. It is not intended to be nor is it a substitute for professional medical advice. You should always seek the advice of your physician or other qualified healthcare provider if you think you may have a medical problem before starting any new treatment, or if you have any questions regarding your medical condition.

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