When it comes to controlling your healthcare, you have every right to take the wheel.
Your doctor ordered an imaging exam and recommended an imaging center.
Should your insurance company be steering you somewhere else?
For your own healthcare decisions, you have every right to be in the driver’s seat. You are probably already used to choosing your own primary care physician. And when your doctor says you need specialty care or a test, you are probably accustomed to your doctor recommending a provider or facility for that care.
But with imaging exams in particular, something unexpected can happen.
Your health insurer may ask you to go to a provider other than the one your doctor recommended for your MRI, CT scan, ultrasound, X-ray, or other procedure. Sometimes, these “recommendations”—a practice called “steerage”—seem so strong that patients feel obligated to do what the insurance company tells them.
But by North Carolina law, you DO have the right to choose your imaging provider. We recommend that you make an informed choice with input from your physician.
So what should you do if your insurer “steers” you to another imaging provider?
Health insurance plans often negotiate with imaging providers to develop pricing agreements that benefit the insurer. Which means that the cost savings end up in the insurance company’s pockets. Even if your insurer tells you that their preferred imaging provider “costs less,” there may be no cost benefit to you. Your copay or deductible responsibility will likely be the same.
Yet your care may NOT be the same.
The imaging provider your insurer is asking you to choose may not have the same level of radiologist expertise or equipment quality as the provider your doctor is recommending.
The solution is to KNOW YOUR RIGHTS so you can make an informed choice.
“Our patients have the reasonable expectation of receiving the right imaging examination, properly and safely performed, appropriately interpreted, and the results communicated in a timely fashion. Their treating physician relationship should be fully maintained. The value of the imaging service(s) provided is complex and includes appropriateness, quality, convenience and cost. Our patients have the reasonable expectation that the information provided to help them make that value determination is accurate, up-to-date, and unbiased.”
ACR-RBMA (American College of Radiology/Radiology Business Management Association)
Below is a list of expectations that your insurance provider should meet. As THEIR customer, you are entitled to choose your imaging provider and/or understand why your doctor’s specific orders have been altered.
- Transparency/disclosure—it should be disclosed to you and the referring physician if the imaging provider selected by your doctor is changed by the insurance company.
- The quality of the facilities must be accurately represented—you should be fully informed about the facility that you are being redirected to including, but not limited to, understanding how it compares to the facility your doctor chose for your care.
- The quality of the exam should be maintained—there is a great deal of variability in credentialing, experience, equipment, etc. You should be fully informed about those factors as they relate to your study at the practice you are being redirected to.
- The costs/savings must be accurately disclosed—it is important to know your out-of-pocket costs as well as the cost that your insurance carrier is covering for the study. As in all areas, cost should not be the only deciding factor. Remember: your doctor chose a particular imaging center for a reason.
- The process should not cause a meaningful delay in diagnosis—like cost, there is a great deal of variability in turn time. That is the time it takes from your actual exam to the time when results are provided back to your physician.
- Continuity of care should be maintained—it is imperative that the imaging group whose services are suggested by the insurance company is as committed to your healthcare strategy as the center selected by your physician.
If your doctor scheduled an imaging exam for you at Greensboro Imaging and you’ve been contacted by your insurance company to get you to go elsewhere, please contact us at (336) 433-5000. We’ll be happy to answer your questions and provide you with specific information regarding your out-of-pocket costs for your exam.