Lakeland Radiologists, Ltd.

My doctors read the x-ray and gave me the results. Why did a radiologist read it?

Your doctor will often look at the x-ray himself, give you his interpretation, and use this information in making his diagnosis and planning treatment. However, he realizes the importance of referring for an expert's advice. Our radiologists are specialists who have extra training and experience and limit their practice to radiology. They independently review all of the information from your imaging exam and prepare a report for your doctor and the facility. Besides providing the benefit of their expertise on the problem you are having, they may be more likely to notice abnormalities unrelated to the current condition (like the small tumor in the lung on the side opposite the broken rib the emergency room doctor diagnosed and focused on treating). They submit a charge for their expertise and time.

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I got a radiology bill from the hospital. Why are you sending me a separate bill?

The "radiology bill" you received from the facility is for what is called the "technical component" of the service. This bill is to cover the cost and overhead of making the image -- it covers things like the cost of the facility, the machines and imaging devices, supplies, technicians and support personnel, transcription costs, etc.

Our radiologists practice medicine independent of the facility. They send a separate bill for what is called the "professional component" of the service. This is to cover their professional services -- such as reviewing the imaging study or performing a procedure and preparing a report about what was done and their findings.

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Why am I getting the bill?

At the time that an imaging study is performed, the facility will have the patient designate who is the "responsible party" for payment purposes. This may be the patient, a spouse, a parent or guardian, or some other third party. Our group uses this information in submitting its bill. Sometimes, the information proves to be incorrect or incomplete. If you believe you are not the "responsible party" and the bill has been sent to you in error -- just contact our billing service to resolve the issue.

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Do you take Medicare or Medicaid?

Lakeland Radiologists, Ltd. is a participating provider with both Illinois Medicare (WPS Medicare) and Illinois Medicaid (IDPA). However, it is the responsibility of the patient to be sure of their eligibility status. In addition, it is important to understand that these programs may require that the patient pay for certain expenses such as deductibles and Co-pays and non-covered services, and that this may result in "out-of-pocket" expenses, even if you're eligible for the program.

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Are you a "preferred provider" or participant in my Health Plan?

Our group has contracts to participate with a number of health plans in our region. However, these contracts and their provisions are always changing. Your plan provides each member with a list of participating providers. If you're unsure whether Lakeland Radiologists participates with your plan at any of our locations, you should contact your plan or refer to your plan information.

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Lakeland Radiologists is a provider for my Health Plan, but one of the doctors isn't.

Even if the group is a participant with a particular health plan, the plans may take six months to a year to "sign-up" or renew an individual physician. During this time, the plan may elect to pay for services provided by that physician at a different rate. We make every effort to comply with these "sign-up" requirements, but we obviously can't control how long the plan takes to do this. We regret any problems or misunderstandings which arise because of this situation.

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Why did you file a claim with the wrong insurance company?

Our billing service receives information regarding your insurance from the facility where your study was performed. This information is sometimes incomplete or incorrect. The wrong insurance card is sometimes presented at the location of service. Employers change insurance carriers. Clerical errors occur. When this happens, the billing service will correct the information as soon as it becomes available and will submit a new claim on your behalf.

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What is a "secondary" insurance payor?

These days, more than one insurance company may be involved in the coverage for services provided. In addition to the main or "primary" insurer, there may be other insurers involved. There may be additional coverage from a spouse's employer. There may be additional coverage such as "Medi-gap" insurance. For certain accidents or injuries, auto or homeowners insurance policies may be involved. Sometimes, the involvement of more than one company, can greatly delay payment, as the companies dispute who "pays first". The responsible party will sometimes make payments while this is sorted out.

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What about refunds?

Rarely, when payments are received from more than one source, the total paid may exceed the original bill. When this occurs, we will promptly refund the credit balance to the appropriate party as soon as we are able to determine who is entitled to the refund.

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The insurance already paid. Why do I still owe more?

There is a common misconception that insurance covers all payments for medical care. Rarely is this the case. Sometimes, insurance provides no coverage. Even when it does make payment, seldom does it pay 100 percent of the cost. Most policies require the policyholder to pay the initial costs for health care incurred in a year -- the deductible -- before the policy makes any payments.

In addition, most policies (even Medicare) have a provision for cost-sharing in which the policyholder is responsible for a portion of every claim -- a co-payment -- (for example 20 percent), even after the deductible is met. We are required by laws and regulations to collect these deductibles and co-payments. They cannot be waived, and the responsible party is obligated to make these payments.

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Why can't you just take the insurance payment?

As we mentioned in the prior question, we are forbidden by federal laws and regulations from waiving the payment for deductibles and co-pays, unless there is demonstrated financial need. This includes the traditional practice of offering "professional courtesy" to members of the medical profession (such as physicians or hospital employees) or their families.

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What if I can't pay the bill?

In cases of severe financial hardship, we do make adjustments to statements. To be eligible for this consideration, you must complete the process for determining financial need at the facility where service was provided. Our billing service will be happy to discuss with you how this is done.

If you're temporarily unable to make full payment on your account, our billing service will make every effort to arrange a payment schedule that you are able to meet.

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Why do you charge more than "usual and customary?"

It is becoming more and more common for insurance companies to deny payment for a portion of the bill on the grounds that the fee exceeds "usual and customary" charges. This is a very misunderstood term. It does not mean that the charge is more than we usually and customarily charge other patients. It also does not necessarily mean that the charge exceeds what other physicians in the area are charging for similar service. If you carefully question the insurance company, you'll discover that the term means whatever they want it to mean. The amount allowed can be equally arbitrary and, in the interest of profits for the insurance company, it is frequently adjusted downward. We make every effort to ensure that our fee schedules are fair and reasonable, but we obviously cannot guarantee they will be less than the amount arbitrarily selected by any insurance company.

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Why do I need "pre-authorization" for some tests or procedures?

Some insurance plans require "pre-authorization" or "pre-certification" before they will cover some types of radiology tests -- such as certain MRI scans, CT scans, and PET scans. Since every plan is different and since the requirements are constantly changing, we can't be responsible for informing you of these requirements. It is the responsibility of the patient or responsible party, working with the referring physician and insurance plan, to determine if authorization is necessary and to provide any necessary authorization numbers to our billing service. If this is not done, the responsible party will be liable for payment.

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I never had x-rays in Charleston. Why am I getting a bill from you?

Our central billing office is in Charleston, Illinois. However, our group provides radiology services at multiple locations , including four regional hospitals, as well as some affiliated and freestanding clinics.

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What insurance do you take?

As a courtesy to the patient and responsible party, our group is always willing to submit a claim or documentation of services to an insurance company. However, whether a test or procedure is covered is always based on criteria outlined in your particular insurance company's plan document. Whether an insurance payment will be made, and for how much, will depend on many factors such as the procedure performed (some companies don't cover certain procedures, or require "pre-authorization"), the diagnosis (for example your policy may not cover maternity benefits or infertility studies), the timing of screening studies, and even the location where the exam is performed. Obviously, we can't know the provisions of everyone's particular policy. If there is a question about coverage, it is the obligation of the responsible party to check with the insurance company and to make payment when coverage is denied.

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