How Radiology Bills Work and What You Can Do About Them

What happens when you get a radiology bill

A radiology bill arrives because you had an imaging scan — X-ray, CT, MRI, ultrasound, or mammogram — and now someone is asking you to pay for it. The bill may come from the hospital or imaging center where you had the scan, or from a separate radiology company that read the images. Sometimes you get two bills: one for the facility (the building and equipment) and one for the radiologist (the doctor who interpreted the images). Both are legal, and both can be negotiated.

The amount you owe depends on whether you have insurance, what your insurance covers, and whether the facility is in your insurance network. If you are uninsured, the facility sets its own price, which can vary wildly — the same MRI might cost $500 at one center and $3,000 at another. Understanding where the bill came from and why it costs what it does is your first step toward managing it.

Key Takeaways

• Radiology bills often split between facility charges (the scan itself) and professional charges (the radiologist's reading), and you may receive separate bills for each.
• If you have insurance, call the facility before your scan to confirm whether they are in-network and what your out-of-pocket cost will be.
• If you are uninsured, call multiple imaging centers to compare prices before your scan, and ask about cash-pay discounts, which can cut the bill by 30 to 50 percent.
• If a bill is wrong or higher than you expected, request an itemized statement and ask the facility to review the charges before you pay.
• Payment plans, financial hardship programs, and charity care exist at most hospitals and imaging centers, even if they are not advertised.

How to find out what you will owe before the scan

Call the imaging center or hospital radiology department at least one day before your appointment. Have your insurance card ready. Ask three things: (1) Is this facility in my insurance network? (2) What is my out-of-pocket cost for this specific scan? (3) Will the radiologist who reads the images be in-network too?

If you are in-network, your insurance has already negotiated a price with the facility. The facility can tell you what your copay, coinsurance, or deductible will be. If you are out-of-network, your insurance may still pay part of the bill, but you will owe more. If you are uninsured, ask the facility for their cash price — not the insurance price, which is higher. Many facilities offer discounts of 30 to 50 percent for uninsured patients who pay upfront or within 30 days.

If the out-of-pocket cost is more than you can pay, ask whether the facility has a financial hardship program or payment plan. Many do, and staff will not mention them unless you ask. Some hospitals have charity care funds that cover scans for low-income patients; ask whether you might be may be able to access.

Understanding the two-bill problem

You may receive one bill from the hospital or imaging center (the facility bill) and a separate bill from the radiologist or radiology group (the professional bill). This happens because the radiologist is often an independent contractor or works for a separate company, not the hospital itself. Both bills are real, and you owe both — but you can negotiate both.

The facility bill covers the equipment, the technician, the room, and the supplies. The professional bill covers the radiologist's time to read the images and write a report. If one bill seems wrong, request an itemized statement from that provider. An itemized statement breaks down exactly what you are being charged for — the scan type, the number of images, any special techniques used. Compare it to what you actually had done. If charges do not match, call and ask for a correction.

If the radiologist is out-of-network and your insurance paid the facility in-network rate, you may owe a larger balance to the radiologist. This is called a surprise bill. Some states have laws limiting how much an out-of-network radiologist can charge you; call your state's insurance commissioner's office to find out whether yours does.

What to do if the bill is wrong or too high

Request an itemized statement immediately. Do not pay until you have it. An itemized statement is your right — facilities must provide it if you ask. Compare the statement to your medical records. Did you have one scan or two? Was contrast dye used (which costs more)? Were multiple body parts scanned? If the statement does not match what you remember, call and ask for an explanation.

If the price is simply higher than you expected, ask the facility to review the charges. Sometimes scans are coded incorrectly, which inflates the bill. Sometimes a facility will reduce the bill if you ask, especially if you are uninsured or paying out-of-pocket. It never hurts to ask: "Can you review this bill? I was not expecting this amount."

If you believe the bill is fraudulent or the facility overbilled your insurance, file a complaint with your state's insurance commissioner or your state's attorney general's office. Both have consumer complaint divisions. Provide copies of the bill, your insurance explanation of benefits, and any written communication with the facility.

Payment plans and hardship programs

Most hospitals and imaging centers offer payment plans, even if they do not advertise them. A payment plan lets you pay the bill in monthly installments instead of a lump sum. Interest rates vary — some are interest-free, others charge 8 to 12 percent annually. Ask what the monthly payment would be and whether there is interest before you commit.

Many hospitals also have financial hardship or charity care programs. These programs reduce or eliminate your bill if your income is below a certain threshold. The threshold varies by hospital, but many cover households earning up to 200 to 300 percent of the federal poverty line. You will need to provide proof of income — recent pay stubs, tax returns, or a letter from your employer. Ask the billing department whether you are may be able to access and what documents to submit.

If you are uninsured and low-income, ask whether the facility participates in any state or federal programs. Some states have programs that cover imaging for uninsured patients. Some imaging centers partner with nonprofits that help pay bills. The facility may not volunteer this information, so ask directly: "Do you have any programs that help uninsured patients pay for imaging?"

How insurance affects what you pay

Your insurance plan determines what you owe in three ways: the network status of the facility, your plan's coverage for that type of scan, and your deductible and coinsurance.

Network status: If the facility is in-network, your insurance has negotiated a lower price. You pay your copay or coinsurance (a percentage of the negotiated price). If the facility is out-of-network, your insurance may pay less or nothing, and you owe the difference. Always confirm network status before your scan.

Coverage: Some insurance plans require prior authorization before you have a scan — meaning the plan must approve it first. If you have the scan without authorization, the plan may deny the claim and you will owe the full bill. Ask your doctor's office to request authorization before your appointment. If the plan denies authorization, ask why and whether you can appeal.

Deductible and coinsurance: Your deductible is the amount you must pay out-of-pocket before insurance starts paying. Your coinsurance is a percentage you pay after the deductible is met. If your deductible is $1,500 and you have not met it yet, you may owe the full radiology bill up to $1,500. Check your insurance card or log into your online account to see how much deductible you have left.

Comparing prices and finding lower-cost options

Radiology prices vary dramatically by location and facility type. An MRI of the same body part can cost $400 at an outpatient imaging center and $2,500 at a hospital. If your doctor has not specified where you must have the scan, you have the right to choose.

Call at least three facilities and ask for the cash price (if uninsured) or your out-of-pocket cost (if insured) for your specific scan. Write down the prices and ask whether they include the radiologist's fee or just the facility fee. Some facilities quote low prices but do not include the radiologist bill, which arrives later. Ask for the total out-of-pocket cost, not a partial quote.

Outpatient imaging centers are often cheaper than hospitals for routine scans like X-rays and ultrasounds. Hospitals are sometimes necessary for complex scans or if you need sedation. If your doctor says you need a hospital, ask why — it may be medically necessary, or it may be habit. If an outpatient center can do the scan safely, your doctor can order it there instead.

Frequently Asked Questions

Can I negotiate a radiology bill after I receive it?

Yes. Call the billing department and ask them to review the charges. If you are uninsured or paying out-of-pocket, ask whether they offer a discount for prompt payment or whether the bill can be reduced. Many facilities will negotiate, especially if you ask politely and offer to pay within 30 days. Request an itemized statement first so you know exactly what you are paying for.

What if my insurance says the radiology bill is not covered?

Ask your insurance company why in writing. Common reasons are: the scan was not authorized, the facility was out-of-network, or the scan was deemed not medically necessary. If you disagree, you can appeal. Ask your doctor to write a letter explaining why the scan was medically necessary and submit it with your appeal. The appeal process usually takes 30 to 60 days.

Do I have to pay a radiology bill right away?

No. You can negotiate payment terms. Call the billing department and explain your situation. Ask for a payment plan, a discount for paying within 30 days, or information about hardship programs. Most facilities will work with you rather than send your bill to collections. Do not ignore the bill, but do not feel pressured to pay immediately either.

What if I get a bill from a radiologist I did not choose?

This is a surprise bill. You did not choose the radiologist; the facility assigned one. If the radiologist is out-of-network and your insurance paid the facility in-network rates, you may owe a large balance. Some states limit how much an out-of-network radiologist can charge you. Call your state's insurance commissioner's office to find out. You can also ask the facility to have an in-network radiologist read your images instead, though this may delay results.

Can I get a radiology scan at a lower cost if I am uninsured?

Yes. Call multiple imaging centers and ask for their cash price. Outpatient centers are usually cheaper than hospitals. Ask about discounts for upfront payment or payment within 30 days — many facilities offer 30 to 50 percent discounts. Ask whether the facility has a financial hardship program or charity care fund. Some nonprofits also help uninsured patients pay for imaging; ask the facility whether they know of any.