Insurance Site of Care Review

As policies around healthcare continue to evolve, some insurance providers are implementing Site of Care Reviews aimed at improving health care services, health outcomes, and overall cost of care. Effective February 1, 2019, UnitedHealthcare will perform Site of Care Reviews for CT and MRI.

 

What is a Site of Care Review?

A Site of Care Review is a way for some insurance companies to determine if the imaging exam your doctor has ordered can be performed in a freestanding outpatient imaging facility as a way of saving you money, while not compromising the quality of care provided.

UnitedHealthcare will be performing Site of Care Reviews for CT and MRI studies as of January 1, 2019. The Site of Care Review will only be conducted if the procedure will be performed in an outpatient hospital setting. There will not be a Site of Care Review if the procedure will be performed in a freestanding diagnostic radiology center or an office setting.

What if the nearest participating freestanding imaging center is a long distance from me?

UnitedHealthcare understands there may be instances when plan members may not be close to a participating freestanding imaging center with the necessary resources for the care they need. In these cases, the procedure will be authorized at a network outpatient hospital facility.

TRA Medical Imaging offers four participating freestanding imaging centers in the south Puget Sound – Tacoma, Gig Harbor, Lakewood, and Olympia. Our outpatient imaging centers are open Monday – Friday, and Saturdays in Tacoma.

Why are Site of Care Reviews only performed for CT and MRI studies?

UnitedHealthcare conducted careful reviews to determine which procedures are clinically appropriate, equally safe and effective if performed at locations other than an outpatient hospital setting. The out-of-pocket cost for plan members may be significant depending on the location where a procedure is performed.

TRA Medical Imaging is committed to offering the most affordable, highest quality care in a welcoming environment. We have a global billing policy which means we send you one bill per visit. Our facilities are independently owned imaging centers so we never charge a facility fee, which can raise the price of your bill.

Where can I go for more information on UnitedHealthcare’s policy on Site of Care Reviews?

You can read more about UnitedHealthcare’s policy on Site of Care Reviews here: https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2018/network-bulletin/October-Interactive-Network-Bulletin-2018.pdf#page=30

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