General Information
CHECK – mailed to our billing office in Lewiston Maine. Please refer to your billing statement for the address. Our multiple office locations will also accept checks.
CREDIT CARD – In person, our multiple office locations can process credit card payments
CREDIT CARD – By phone – our billing department can be reached to process payments at 1-888-912-7583, Monday – Friday 8:30am – 4:45pm.
Also – check your insurance plan to see if you have a deductible and/or co-insurance (see above for explanation).
If you have insurance and we do not have it on file – please contact our billing company 1-888-912-7583 with the correct insurance information.
Deductible: an out of pocket dollar amount (example – $2000, $5000+) set up within your insurance plan. This amount must be paid prior to the insurance carrier paying for diagnostic medical procedures.
Co-Insurance: a percentage set up by your insurance carrier where the patient/family is financially responsible for a ‘percentage’ of the insurance carriers contracted rate for the specific procedure performed.
Mammography
State of Connecticut Law states if a patient has preventative benefits, they cannot incur any out of pocket expense for screening mammograms. If you received a bill for your ‘annual’ mammogram, there is a chance it was a diagnostic mammogram. Annual does not equate to screening/preventative. Screening/Preventative = without signs/symptoms of breast disease. If you previously have/had an issue your doctor may have asked for you to have a ‘diagnostic mammogram’ to document possible changes or stability.
Imaging performed on patients whose doctor requested a diagnostic exam or a patient with clinical signs/symptoms of possible breast disease, a history of breast cancer, follow up to previous findings to document possible changes or stability or other factors (in the opinion of the referring physician) that make a diagnostic exam necessary. Diagnostic mammography captures as many images as needed to fully analyze both breasts and include special images to an area of possible concern or documented problem. Billing Information: Although insurance carriers ‘cover’ diagnostic exams, if your plan has a deductible or co-insurance which has not yet been met, this diagnostic mammogram will be put towards it and your insurance carrier may leave the balance as your responsibility.
Due to the signs/symptoms you have documented or the results from a past breast examination, Advanced Radiology Consultants feels it would be best to perform a diagnostic study today. A call will be made and this change will be discussed with your physician. Billing Information: Although insurance carriers ‘cover’ diagnostic exams, if your plan has a deductible or co-insurance which has not yet been met, this diagnostic mammogram will be put towards it and your insurance carrier may leave the balance as your responsibility.
Imaging performed on patients without signs/symptoms of breast disease, discomfort or past findings requiring follow up. Screening mammography generally captures two, more if needed, images of each breast. (WOMEN ONLY) Billing Information: Screening/Preventative mammography will be applied towards ‘Preventative Benefits’ by insurance carriers ‘IF’ your insurance plan includes Preventative Benefits.
Breast Ultrasound
When bilateral ultrasounds are performed, they are now billed with 2 codes (see above). Regardless of the amount billed/charged to the insurance company, our payment is based on our contracted rate (see FAQ’s for explanation) with your insurance carrier. Although the billing codes are new, the method of payment set in our contract has remained the same. The same method is used on old and new billing codes; the amount you are financially responsible for has been set up by your insurance carrier.
As of 1/1/2015, the American Medical Association (AMA-creates billing codes nationally) created 2 new billing codes for an ultrasound of the breast. Previously, there was only one billing code was used for a unilateral and/or bilateral breast ultrasound. The new billing codes specifically state ‘unilateral’. Each time a bilateral ultrasound is performed, 2 billing codes will be billed.
The State of Connecticut Law indicates all insurance carriers must ‘cover’ screening ultrasound of the breast(s) on women with either dense breast tissue or who are considered by their referring doctor to be high risk (20% or higher). The word ‘cover’ means, they must process the claim as a medical procedure. If your insurance plan has a deductible (see billing FAQ’s for explanation), the ultrasound will be processed towards it leaving you financially responsible for the contracted rate (see billing FAQ’s for explanation). If your deductible has been met and you do not have a co-insurance, your insurance carrier will pay for the claim.
A screening ultrasound survey of the breast due to image proven dense breast tissue AND a targeted ultrasound of the breast(s) on women with abnormal clinical findings (reported by referring physician), inconclusive findings on mammography or follow up to previous finding to document possible changes or stability.
Screening/Preventative Ultrasound must be ‘covered’ by insurance according to the State of CT law BUT most insurance carriers WILL apply this exam to a deductible if you have one as the law currently allows.
A targeted ultrasound of the breast(s) on women with abnormal clinical findings (reported by referring physician), inconclusive findings on mammography or follow up to previous finding to document possible changes or stability.
Although insurance carriers cover diagnostic exams, if your plan has a deductible or co-insurance which has not yet been met, this diagnostic ultrasound will be put towards it and your insurance carrier may leave the balance as your responsibility.
A screening survey of the breast(s) using ultrasound on women with image proven dense breast(s) or if a women is believed to be at increased risk for breast cancer due to family history, prior personal history of breast cancer, positive genetic testing or other indications as determined by the referring physician.
Screening/Preventative Ultrasound must be ‘covered’ by insurance according to the State of CT law BUT most insurance carriers WILL apply this exam to a deductible if you have one as the law currently allows.
