United Healthcare Patients: Your insurance for imaging tests here has changed

UnitedHealthcare has reduced its coverage affecting multiple imaging providers nationwide, including Inland Imaging (used by PacMed, also operating as Integra Imaging) and Radia Inc. (used by Swedish and Providence).

As a result, the read or professional fee here – about 30% of the total for imaging tests – will now be processed as out-of-network by your UnitedHealthcare plan. This change took effect March 16, 2021.

PacMed, and the larger facility or technical fee both remain in-network.

Outside physician groups, such as Inland Imaging, bill separately from PacMed.

Why Inland is still a great choice
Imaging tests done here in PacMed facilities are interpreted or “read” exclusively by our partner, Inland Imaging.

Even though UnitedHealthcare (UHC) changed your coverage, having tests done here may still be more convenient and comparable or less expensive than other imaging locations.

  • Inland may have similar or lower costs  
    Out-of-network coverage alone does not determine your cost. Another factor are the contracted rates each facility charges. For example, Inland is continuing to honor Medicare rates for Medicare Advantage patients, even though UHC is not contracting with Inland on those plans.
  • No delays
    You’ll have results in your chart within about 1-2 days if your imaging test is done here with Inland, within our continuum of care. When working with outside providers, we have experienced delays of up to 4-6 weeks at times.
  • Convenience
    Inland facilities are located right here within PacMed. You won’t have to travel to a new location or navigate getting your results back to your PacMed provider.

What you can do

Patients are entitled to get information to help you make informed decisions. You can ask your insurance for an estimate of your out-of-pocket costs for tests your doctor ordered, before seeking care:

  1. Ask Inland Imaging at PacMed for the CPT and ICD-10 codes: 1.206.326.6500 *
  2. UnitedHealthcare: call the number on your insurance card or 1.877.844.4999. Share the codes and ask what your out-of-pocket costs will be.

Only your insurance plan can give an estimate of your actual costs, since it involves coverage details only your insurance company has access to.

* The codes we are able to provide in advance only include what your provider has anticipated you will need. In the course of treatment, sometimes emergent needs are discovered that the provider decides are best dealt with at that time. Additional service codes may then apply later that cannot be known in advance.

 

Questions you may have

Which UHC plans are considered out-of-network with Inland Imaging?

All UHC commercial network and United Healthcare Medicare Advantage plans are considered out-of-network.

What types of tests are affected by this change?

This impacts all imaging exams, such as X-ray, ultrasound, mammogram, MRI and CT scans.

Why are there different charges for the same test? What is the difference?

Imaging exams involve two basic steps: First, “taking the picture” – then, interpreting what it means.

  1. The technical or facility fee for processing the image typically makes up 70% of the charge; this falls under PacMed and remains in-network with UHC.
  2. The read or professional fee typically makes up 30% of the charge; this is the service performed by Inland that is now considered out-of-network by UHC.

Please note, Inland Imaging bills come from their parent company, Integra Imaging, PS.

I received a bill from Integra Imaging, PS. What is that?

This is your Inland Imaging bill.

Inland Imaging is a division of Integra Imaging, PS and bills under their name. If you receive a bill from Integra Imaging, PS, that simply reflects the amount left over from services provided by Inland Imaging that insurance did not pay.

If you have questions about this bill when you receive it, you can call United Healthcare to ask what charges they paid or denied, and why. You can also call Inland/Integra at patient accounts at 1.888.737.4455.

Do I have out-of-network benefits?

Out-of-network benefits vary by plan and service. You will need to contact your insurance company to determine your out-of-network benefits. The phone number can be found on your insurance ID card.

What will my out-of-pocket costs be?

We can’t answer this question because it is based on factors that are different for each patient, and we don’t know the information.

Your insurance company has these details. The factors include:

  • Your insurance coverage, in-network or out-of-network
  • Your deductible (how much you need to spend each year before insurance will pay)
  • How much you have spent so far this year
  • The contracted rates for the services you are seeking (these are usually less than a company’s list price, and different for each company based on negotiations with the insurance company).

We recommend you contact your insurance company to find out what your costs will be for treatment, based on the factors above.

How can I find out my out-of-pocket costs?

You can ask your insurance for an estimate of your out-of-pocket costs for tests your doctor ordered, before seeking care:

  • Ask Inland Imaging at PacMed for the CPT and ICD-10 codes: 1.206.326.6500 *
  • UnitedHealthcare: call the number on your insurance card or 1.877.844.4999. Share the codes and ask what your out-of-pocket costs will be.

Only your insurance plan can give an estimate of your actual costs, since it involves coverage details only your insurance company has access to.

* The codes we are able to provide in advance only include what your provider has anticipated you will need. In the course of treatment, sometimes emergent needs are discovered that the provider decides are best dealt with at that time. Additional service codes may then apply later that cannot be known in advance.

What are CPT and ICD-10 codes?

These are the codes that your doctor uses to order specific services and to communicate to your insurance company what was done and why.

CPT codes are procedure codes that describe the services performed or ordered.

ICD-10 codes are diagnosis codes that describe why those services were done or recommended.

Why isn’t Inland Imaging in-network with UHC anymore?

Inland is an outside physician group and negotiates contracts with insurance companies independent of PacMed.

During final contract negotiations, the parties could not agree on a more sustainable fee structure.

Inland remains in-network and has reached agreement on rates with every other major payor in the region.

Negotiations between Inland Imaging and UHC are ongoing, and we hope that this situation is resolved shortly.

I would like additional information, who can help me?

  • Inland Imaging has a support team to help answer your questions. Patients can contact Inland customer service at 1.888.737.4455
  • You can contact your insurance company. The phone number can be found on the patient’s insurance ID card, or call UHC customer service at 1.877.844.4999.