Need help understanding coverage for CT scans and MRIs with UMR health insurance “in office” clause.
My plan states the following
Imaging (CT/PET scans, MRIs) No charge: Deductible Waived Office setting; 20% Coinsurance Outpatient setting
Now this doesn’t make any sense for a number of reasons what doctor has a CT or an MRI machine in their office? Outpatient is basically anywhere they send me which is what any doctor would do to a hospital. You need a CT scan or an MRI they’re gonna send you to a hospital or down the hall the radiology or whatever and that is considered an outpatient procedure. The only one that kind of made sense was when I had an EMG and I got an estimate for 5000 and then after insurance coverage it was gonna be about 2800 or something, but it ended up being free. She did do it right in her office.
But I don’t understand the concept of an in office CT or MRI. Of course I called the insurance company probably five times and tried to have this explained to me and they were just as confused as me. Of course there’s a language barrier because your entire customer service is located in India. One person finally gave me a list of providers that were supposedly in office that could do radiology. I called these providers one by one and they’re just a list of network doctors that have nothing to do with having MRI or CT scans in their office.
In fact, a couple of the providers listed in my primary care doctors building so clearly he just sent me a list of network doctors that were nearby that have nothing to do with whatever this concept of in office MRI or CT scan is. I called the billing department for Aurora. I have talked to simonmed and MDI. I’ve talked to a multitude of places nobody has ever heard of this. Is this just bullshit or is there some concept that I’m not understanding or missing it? Is there some doctor I could go to where all of my imaging would be free with UMR?
Does anybody have any idea who I should call? Because if none of the providers can help me in the insurance company can’t help me and my doctor clearly doesn’t know anything about it nor any of the specialist. I’m at a loss. I would’ve provided a picture of my plan which showed this part, but this sub does not allow pictures.