Billing - Insurance Pre-Authorization

It is important for patients to take the following steps before their appointment: 

  • Patients are responsible for finding out if Advanced Imaging Center is an in-network provider for their plan and if their plan requires pre-authorization. 
    • Insurance companies may call the process of Pre-Authorizing an exam pre-authorization, pre-certification, prior notification, pre-notification, RQI, and/or Pre-Determination.
    • Worker's compensation, automobile, or personal injury cases may also require pre-authorization and, if applicable, the name and address of the patient's attorney.
  • If any of these processes are required the patient is responsible for contacting their insurance company(ies) to find out what information is needed to obtain "pre-authorization." 
    • The phone number is usually found on the back of the insurance card. 
    • Patients are strongly encouraged to work closely with their physician's office to ensure that all pre-authorization requirements are satisfied before the exam. 
    • Patients are welcome to call the front office at (309) 743-0445 for pre-authorization assistance if needed. 

  Advanced Imaging Center is a Medicare provider: 

  • Medicare requires that all exams have a supporting diagnosis to demonstrate that it is medically necessary.   
  • If your physician orders an exam for a diagnosis that DOES NOT meet Medicare Medical Necessity you will be asked to sign an Advanced Beneficiary Notice (ABN). 
  • The ABN informs you in advance that Medicare is not likely to pay for the exam. You will have the option of proceeding with the exam and agreeing to be financially responsible. 
  • If you refuse the exam you will still be asked to sign the ABN indicating you have elected not to proceed. 
  • Medicare PPO's, also known as 'Medicare Replacement' plans can also require exam Pre-authorization.
  • Patients are strongly encouraged to check with their insurance companies about pre-authorization requirements and to work closely with their physician's office to ensure that all pre-authorization requirements are satisfied before the exam. 

Patients must provide Advanced Imaging Center with complete insurance information; this includes:

Insurance card, name and address of the insurance plan, claims payer, the ID and group numbers, and the name of the subscriber. 

Each exam will result in two bills:

  1. Advanced Imaging Center for the technical component (the actual scan itself).
  2. Advanced Radiology, S.C. for the interpretation of the exam by a radiologist (reading fee). This includes a consultation with your ordering healthcare provider.
Advanced Radiology, S.C. handles the billing for both services, and can be reached for billing questions at (309) 762-1072. If a patient does not have medical insurance and/or is concerned about paying for the procedure, they should contact the billing office. Ultimately, the patient is responsible for payment of the accounts, including any deductible and/or balance not covered by their insurance plan.
 

HIPAA

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please be sure to read it carefully.



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