On behalf of our partners at Radia (radiologists who provide services to EvergreenHealth patients), we are sharing a notice from Radia Imaging & Technology Services that informs United Healthcare Group (UHG) patients of a recent change of in-network status for Radia services for UHG members, effective Apr. 1, 2021.
Our goal is to help ensure United Healthcare Group patients are aware of this possible change to your Radia services coverage and invite you to please call 866.948.5717 for questions.
As a result of a notice from United Healthcare Group (UHG) to Radia, the physicians who provide medical supervision, quality assurance and interpret your imaging studies (including procedures and mammography) may be out of network with UHG.
Beginning January 1, 2020, Washington state law protects you from ‘surprise billing’ or ‘balance billing’ if you receive emergency care or are treated at an in-network hospital or outpatient surgical facility
Under your health plan, you’re responsible for certain cost-sharing amounts. This includes copayments, coinsurance and deductibles. You may have additional costs or be responsible for the entire bill if you see a provider or go to a facility that is not in your plan’s provider network.
Some providers and facilities have not signed a contract with your insurer. They are called ‘out-of-network’ providers or facilities. They can bill you the difference between what your insurer pays and the amount the provider or facility bills. This is called ‘surprise billing’ or ‘balance billing.’
Insurers are required to tell you, via their websites or on request, which providers, hospitals and facilities are in their networks. And hospitals, surgical facilities and providers must tell you which provider networks they participate in on their website or on request.
The most you can be billed for emergency services is your plan’s in-network cost-sharing amount even if you receive services at an out-of-network hospital in Washington, Oregon or Idaho or from an out-of-network provider that works at the hospital. The provider and facility cannot balance bill you for emergency services.
Certain services at an In-Network Hospital or Outpatient Surgical Facility
When you receive surgery, anesthesia, pathology, radiology, laboratory, or hospitalist services from an out-of-network provider while you are at an in-network hospital or outpatient surgical facility, the most you can be billed is your in-network cost-sharing amount. These providers cannot balance bill you.
In situations when balance billing is not allowed, the following protections also apply:
If you receive services from an out-of-network provider, hospital or facility in any OTHER situation, you may still be balance billed, or you may be responsible for the entire bill.
This law does not apply to all health plans. If you get your health insurance from your employer, the law might not protect you. Be sure to check your plan documents or contact your insurer for more information.
If you believe you’ve been wrongly billed, file a complaint with the Washington state Office of the Insurance Commissioner at www.insurance.wa.gov or call 1-800-562-6900.