In May 2023, the health plan adopted Site of Care Incentives to promote the use of independent labs and radiology. When covered individuals use these independent facilities, it drives out of pocket cost down for you, and the overall cost for the plan is significantly less.
However, there has been a lot of confusion regarding which independent, freestanding radiology facilities are a part of the site of care incentive benefit. Some hospital-system radiology centers refer to their facilities as “freestanding,” but they are not contracted as and do not bill as freestanding facilities; they bill as a hospital system. In addition, some non-hospital radiology facilities are owned and operated by physician groups, which further complicates the definition.
What you need to know
The site of care radiology incentive for X-rays, MRIs and similar, receive a $25 copay only when they are independently owned, freestanding imaging facilities (not hospital or physician group owned).
If you have any questions or would like to check if an in-network radiology facility near you meets the site of care incentive standards, please contact Participant Services.
