The Scan Is Ordered. Price the Facility and the Radiologist Before You Book

Your parent is going home with an order for an X-ray, CT scan, MRI or another image. Do not leave with only the name of the test.

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You need enough detail to price the whole service. The facility may send one bill. The radiologist who reads the image may send another. The amount can also change when the same test is performed in a hospital outpatient department instead of an independent imaging center.

Medicare says the type of facility and the place where a diagnostic test is performed can affect the patient cost. For covered tests in a doctor’s office or independent diagnostic testing facility, a person with Original Medicare generally pays the applicable Part B deductible and coinsurance. A hospital outpatient test may also carry a hospital copayment. Medicare also tells patients to confirm that certain independent providers are accredited. (Medicare, Diagnostic Non-Laboratory Tests.)

Day 0, still in the bed: get an order you can price

Ask the hospital clinician or discharge planner for a copy of the imaging order. Check it before you leave.

Write down:

• The full name of the test.
• The body part and side.
• Whether the order calls for contrast.
• The reason or diagnosis written on the order.
• The CPT or HCPCS code, if the ordering office can provide it.
• When the clinician wants the test completed.
• Who will receive and discuss the result.
• Whether the order names a required facility.

Do not choose a cheaper version of the test yourself. If a facility says the written order does not match what its staff expect to perform, send the question back to the ordering clinician. The order is the common description you will use when asking each place for a price.

Ask whether the hospital has already scheduled the test. A printed appointment is not proof that the facility, radiologist or service is covered by your parent’s plan.

Day 1, the car pulls in: separate the possible bills

Call the imaging location. Read the order exactly as written. Ask these questions:

• Is this a hospital outpatient department, a physician office or an independent diagnostic testing facility?
• What is the facility’s legal billing name?
• Will the facility bill for the scan and a separate radiology group bill for reading it?
• What is the radiology group’s legal billing name?
• Does the estimate include contrast, supplies and the radiologist’s interpretation?
• Could any other professional bill separately?
• Does this test require a visit before the scan?

This separation matters locally. BJC HealthCare’s public CT information says a patient may receive one bill from the facility and another from the radiologist. BJC’s cost estimator says its hospital estimate does not include physician or other professional fees. Mercy and SSM Health also warn on their public estimate pages that professional charges may be separate or excluded. (BJC HealthCare, CT Scan and Patient Cost Estimator; Mercy, Online Cost Estimator; SSM Health, Price Transparency.)

Ask for the answer in writing when possible. Save the facility name, radiology group name, code, estimate number and the name or department of the person who provided it.

Day 2 to Day 3, the first full days: call the insurance plan with both names

Use the number on the insurance card. Do not ask only whether the hospital system is covered. Give the representative the exact facility name, radiology group name and billing code.

Ask:

• Is this facility in network for this specific plan?
• Is the radiology group in network?
• Is prior authorization required?
• Has authorization already been requested or approved?
• Does the plan require a particular imaging location?
• What deductible, copayment or coinsurance applies at this type of facility?
• Is the estimate based on the facility charge, the professional charge or both?
• Is there a lower-cost in-network location that can perform the exact ordered test within the requested time?

Record the reference number for the call. An authorization is not a price promise, and an estimate is not an authorization. Keep the two answers separate.

If your parent has Original Medicare, use the coverage rules for the exact test and ask the provider whether it accepts Medicare assignment. If your parent has Medicare Advantage, call the plan because its network, referral and authorization rules may differ.

Day 3 to Day 7, the week: compare complete estimates

Compare at least two suitable locations if the ordering clinician says the location is flexible. Give each one the same order, code and insurance information.

Put the answers in five columns:

• Facility name and facility type.
• Facility estimate.
• Radiologist or professional estimate.
• Insurance response and authorization status.
• What the estimate excludes.

Hospital sticker prices are not the same as your parent’s likely out-of-pocket amount. Federal hospital price transparency rules require hospitals to publish standard charge information and provide a consumer-friendly display or qualifying estimator for shoppable services. The rules also address ancillary services commonly connected with the main service. (CMS, Hospital Price Transparency; 45 CFR Part 180, including section 180.60.)

Use the hospital estimator as a starting point. Then ask for an insurance-specific estimate tied to the exact order. BJC HealthCare, Mercy and SSM Health each provide public routes for requesting estimates, but their own pages explain that actual bills can differ and that professional charges may not be included.

If an estimate is much lower, find the missing line before choosing it. Ask whether it excludes the radiologist, contrast, supplies or another facility charge. If an estimate is much higher, confirm that the location was classified correctly and that the right insurance plan and code were used.

Before the appointment, close the loop

Call the chosen location once more. Confirm that it has the signed order, any required authorization and the clinician’s instructions. Ask what identification, insurance information and prior images your parent should bring.

Also confirm who will receive the result. Ask the ordering office how your parent will learn the result and whom you should call if no one contacts you. This is a handoff question, not a reason to interpret the image yourself.

Keep the order, estimates, authorization record and call notes together. When bills arrive, match each bill to the names and services you recorded. If a bill contains a different location, group or code, call the biller and the insurance plan before paying it.

The price usually moves for identifiable reasons: the exact test ordered, the facility type, the facility’s network status, the radiologist’s network status, separate professional billing, the remaining deductible and any authorization requirement. Your job is to put those parts on one page before the appointment.

For the source list behind this guide, see Sources. For the rest of the discharge sequence, use Day 0 to Day 14 After Discharge.