Wake Radiology Managed Care and Insurance Information

Wake Radiology is a contracted, in-network provider for most major managed care insurance plans. For patients whose plans are not within our managed care network, we file claims on their behalf. For questions related to insurance, please contact our business office.

Wake Radiology now accepts TRICARE military coverage for all clinical services. Previously, Wake Radiology accepted TRICARE for only breast-related imaging. As of February 1, 2012, we accept and file TRICARE plans – both primary and secondary – for all radiology services.

Wake Radiology accepts workers’ compensation cases and files claims to all carriers. We accept workers’ compensation cases, file claims to all carriers and honor the North Carolina Industrial Commission (NCIC) fee schedule for workers’ compensation. Although we do not participate with workers’ compensation brokering/3^rd party networks (e.g., OneCall Medical, Corvel and DiaTri), most workers’ compensation insurance carriers authorize imaging services when Wake Radiology is a referring provider’s preference. Of note, we interact with workers’ compensation carriers to confirm NCIC rates and obtain authorization for service.

Financial assistance. Wake Radiology recognizes that some patients do not have insurance and/or require financial assistance. We offer payment plans to ease their cash flow burden or prompt payment discounts to lower their out-of-pocket costs.

Wake Radiology’s Managed Care List

Wake Radiology continues to align its managed care contracts with those of its referring physicians. If there are additional plans that we should consider, please contact Michele Jackson at (919) 788-7904 or via fax (919) 789-4461.

Wake Radiollgy participates with in-network insurance and files claims. For out-of-network plans, Wake Radiology accepts insurance and files claims with these carriers. There may result in a higer deductible or co-insurance for the patient.

Download our managed care list

Private Insurers

Aetna
American Healthcare Alliance (AHA)*
Assurant Health*
Atlantic Inegrated Health / Beacon Company*
Beech Street*
BlueCross BlueShield of North Carolina
BlueCross BlueShield – states outside of NC
Cigna Health Care
Conventry National*
Conventry (Wellpath)
Duke Select / Duke Basic*
Evolutions Healthcare Systems*
First Health*
Foremost*
Four County Health Network*
Great-West Healthcare (Cigna)
Humana Choice Care Network*
Inclusive Health (NCHIRP)
MAMSI Life & Health*
MDI – Medical Partners of America
MedCost
MultiPlan*
NC Smart Choice Blue Option
NC State Health Plan
NPPN / Plan Vista*
OneNet (formerly Alliance)*
Paradigm Health Corporation*
Piedmont Health Coalition (WellPath)
Premier Health Systems*
Primary PhysicianCare
Private Healthcare Systems (PCHS)*
Three Rivers Provider Network (TRPN)
UnitedHealthCare*
WellPath (Coventry Health Care of the Carolinas)

Government/Military

CHAMPVA
Medicare Part B
Medicaid of North Carolina
Medicaid (states outside of NC)*
Tricare
Tricare for Life (secondary to Medicare)
Veteran’s Administration (with proper VA referral)

Medicare Part B Supplement Plans

All private-fee-for-service (PFFS) plans
Aetna Medicare PPO*
Blue Medicare HMO and PPO
Cigna Medicare Services*
Evercare*
Humana Choice PPO*
UnitedHealthCare Medicare Complete*
WellPath Advantra PPO*

* Out-of-network plans: Wake Radiology accepts insurance and files claims with these out-of-network carriers. Services may result in a higer deductible or co-insurance. Patients are encouraged to contact their insurance carrier to discuss their specific plan details.

Wake Radiology’s representatives are available to answer your insurance, billing and payment questions. Please contact our team Monday – Friday from 7:00 am – 5:00 pm. Chuck Wilcox serves as our business manager.

Insurance Resources

Use these links for updated information about consumer insurance, insurance premiums assistance, etc.

NC Department of Insurance – Services for Consumers

Consumer Guide to Health Insurance

Need Help with Medicare? The Seniors’ Health Insurance Information Program (SHIIP) is housed under the NC Department of Insurance, and is dedicated to providing free, unbiased insurance advice to seniors and their families. Call 1-800-443-9354 or visit them online.

Managed Care Patient Assistance Need help with insurance problems in North Carolina? Call Managed Care Patient Assistance at 1-866-867-6272 or via email su.cn.etats.suj.liamnull@APCM

North Carolina Department of Insurance Managed Care—Consumer Division The goal of the Consumer Services Division is to respond to questions and complaints concerning insurance and to provide consumers with alternatives and courses of action to solve a particular insurance problem. NCDOI can forward your complaint to the insurance companies, obtain information or explanations on your behalf from the insurance companies and explain your options. NCDOI Consumer Services can be reached at 1-800-546-5664.

Self-Insured Employers If you are insured as a result of your or your spouse’s employer, your rights under your health plan may be governed by the Employee Retirement Income Security Act (ERISA) under the U.S. Department of Labor. If so, state law will not generally apply to your group health plan. Instead you will need to contact the U.S. Department of Labor for consumer information and assistance. The law requires that your plan sponsor provide you with a “summary plan description”. The employer may also be able to overturn a decision of the plan administrator, especially with regard to a medical necessity determination. Contact: 1-866-4-USA-DOL or http://www.dol.gov/dol/topic/health-plans/index.htm.

Health Care Reform The passage of health insurance reform legislation represents a historic victory for the American people – a victory over the special interests that have fought for decades to prevent families and businesses from having control over their health care or the health care of their workers.