7301 Medical Center Dr.
West Hills, CA 91307-1904
Phone: (818) 346-4411
Fax: (818) 346-1798
Insurance & Payment
Paying for health care services is often complex and confusing. Things like primary and secondary insurance coverages, co-payments, deductibles, and pre-authorizations are frequently viewed as overwhelming. In an effort to simplify things, our patients typically authorize us to bill and collect payment directly from their insurance companies. With that said, please keep in mind that you, the patient, are still responsible for your co-payments and deductibles and are ultimately responsible for any charges not covered by your insurance company. In an effort aimed at being helpful, we attempt to verify insurance coverage prior to the appointment so that you will understand the extent of any financial obligation before receiving services.
The type of insurance coverage you have (e.g., Government, HMO, PPO, POS, etc.), will determine the amount of money, if any, you must pay for medical imaging services. West Valley Imaging Center accepts Medicare and is a contracted provider with most national and local health plans. Please contact us to discuss alternative payment arrangements should you not have insurance coverage.
Medicare typically pays for diagnostic imaging services considered "medically necessary" under Medicare guidelines. West Valley Imaging Center submits claims for Medicare covered services. Medicare contracts with private carriers who administer the payment of claims for the government. You will receive and "Explanation of Benefits" or "Medicare Summary Notice" from the private carrier who processes the claim, and West Valley Imaging will receive payment directly from the carrier. If there is any balance due, you will then receive a statement or a bill from us for that balance. Balances are normally due because deductible have not been met or for unpaid co-payments.
Waiver of Medicare deductibles and co-payments is a violation of federal law except for documented hardship situations. Supplemental insurance may cover co-payment obligations.
For more information about Medicare, visit http://www.medicare.gov.
ABN (Advance Beneficiary Notice)
In situations when Medicare does not cover the medical services requested, we require patient to sign an ABN. The ABN is a form Medicare requires to informs the patient they may have to pay for the services if Medicare refuses payment. The ABN confirms West Valley Imaging Center's right to bill you for the entire cost of the imaging services up to the Medicare allowable, if applicable.
Since Medicare pays only for tests that it considers to be "medically necessary", Medicare requires medical providers to clearly communicate with the patient if the services requested are not covered. Under Medicare guidelines, some tests are not considered medically necessary, even though ordered by a treating physician. Medicare considers most tests medically necessary depending on the patient's diagnosis and other clinical factors. If the patient's diagnosis does not fall under Medicare guidelines for medical necessity, Medicare won't pay for it, and an ABN is required.
Many patients get concerned that they are having unneeded tests is Medicare will not cover them. Physicians' opinion of medical necessity is often different than the Medicare guidelines. Medicare guidelines are based on broad circumstances and are inflexible in many cases. Conflict between a physician's opinion and Medicare coverage determinations should not be viewed as an attempt to give the patient unnecessary care. Patients should address specific concerns with their physician.
ABNs are not mandatory. When asked to sign an ABN a patient may either:
FOR MORE INFORMATION CONTACT Medicare at 1-800-252-6550 or visit their web site at www.hcfa.gov
A variety of private health plans operate as HMOs, PPOs and POS. Patients should be aware of the particular requirements for coverage under their plans. Questions may be directed to the health plans directly. We will attempt to assist patients in determining whether coverage is valid for any procedure.
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