Insurance Resources

The majority of insurance plans today pass a portion of their cost of care to patients, in the form of a deductible and/or co-insurance. For patients whose plans are not within our managed care network, we can still provide imaging services as well as file claims on their behalf. It’s important to note that most of these insurance plans (including UnitedHealthcare) do have out-of-network benefits that cover Wake Radiology imaging fees. However, these out-of-network services may result in a higher cost share to the patient. We recommend you talk to your insurance carrier with questions about our network status and your anticipated cost of care with us. Patients may be able to reduce their net out-of-pocket cost by using Wake Radiology’s prompt-pay discount. This allows patients to pay at the time-of-service and receive reimbursement once their insurance carrier pays the claim.

• Managed Care Patient Assistance Program (MCPA). Created as part of the NC Patient’s Bill of Rights, the MCPA provides education, advice, support and information for North Carolina consumers with health insurance issues. They provide basic information about how health insurance works, help interpret Explanation of Benefits (EOB) documents and provide direct assistance to those who want to appeal the denial of health care services by their health insurance company. They can be reached at 1-855-408-1212.

• North Carolina Department of Insurance (NCDOI). This department educates consumers about different types of insurance, handles consumer complaints and more. Patients can reach NCDOI by phone or online at ncdoi.com. 
  • Consumer Services. This division has consultants trained to help the general public with a variety of insurance issues involving auto, homeowners/renters, liability, life/annuities, disability, Medicare supplement, long-term care, dental, vision, hospital, accident, specified disease and other coverages. They answer insurance questions and help educate the public on available avenues to resolve insurance related problems. Call 800-546-5664 or 919-807-6750 or visit their website. However, please note that most health insurance questions should be directed to Health Insurance Smart NC and most Medicare questions should be directed to Seniors’ Health Insurance Information Program SHIIP.
  • Health Insurance Smart NC. This division is the state’s primary source of health insurance information and assistance for all people not on Medicare. Call 877-885-0231 or visit them online.
  • Seniors’ Health Insurance Information Program (SHIIP). This division provides free, unbiased insurance advice to seniors and their families. Call 1-800-443-9354 or visit them online.
  • The Consumer Guide to Health Insurance. This booklet can be accessed on their website.

• US Department of Labor. 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 US Department of Labor. If so, state law will not generally apply to your group health plan and you will need to contact the Department of Labor for 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. Call 1-866-4-USA-DOL or visit their website.

• The Affordable Care Act (ACA) of 2010. The ACA health insurance (also known as “Obamacare”) reform legislation was passed by Congress and signed into law by President Obama on March 23, 2010. For more information on how this historic legislation impacts your healthcare, visit their website.