Went to my PCP and complained about an abdominal pain. She referred me to a radiology center to do an ultrasound (I have a paper referral). Does this mean it will be fully covered? the representative at the radiology center says he doesn’t see any costs and that I won’t have to pay for the procedure. I have a high deductible plan so it sounds strange but he told me that billing will say the same thing. Does it mean that I may be billed according to the results? I’m so baffled…
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Covered doesn’t mean free. It means you’ll pay based on your plan.
With an HDHP, you must pay the full negotiated rate for care until you meet your deductible.
Since this is diagnostic imaging, it will be billed that way.
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Referrals don’t affect the cost.
Call your insurance company to check if your deductible applies, which it likely will.
Don’t rely on the office for accurate information.
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A referral lets you get the ultrasound.
Make sure the place you go to is an “in-network provider” that accepts your insurance. It’s hard to believe there’s no cost for the patient.
Call your insurance company to confirm what’s covered and what you’ll need to pay. With a high deductible, don’t just rely on what the radiology office tells you.
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Ok
thanks for the suggestion.
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It’s your responsibility to check if your insurance will cover the service, fully or partially.
Don’t rely on the provider—trust only your Explanation of Benefits (EOB).
Make sure both the facility and provider are in your insurance network. You’ll likely have at least a copay.
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I think the insurance might tell you to check with the provider.
When you call, ask: “Is this provider in-network?” and “What will my out-of-pocket costs be for this service?”
It’s possible to get an estimate, but sometimes the exact cost is hard to know before the service.
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Ask your insurance for an estimate of your out-of-pocket costs.
If you have a deductible and the service costs less than your deductible, you’ll likely pay the full amount. This applies if you haven’t met your deductible yet.