Insurance Resources

Pre-Certification

  • Pre-Certification is required for most MRI and CT Scans.
  • Allow 2-3 business days to obtain and verify pre-certification.
  • Emergency pre-certifications can sometimes be obtained within 3 hours.
  • Some insurance plans may require the patient to call their change site line to choose Montclair Radiology.
  • Insurance Plans may attempt to assign a radiology facility to the patient. The patient has the right to choose Montclair Radiology.
  • Horizon NJ Health requires notes and a minimum of 5 days

Montclair Radiology’s Billing and PreCertification department can be reached at 973-284-0020 (option 2) or by e-mail at precert@montrad.net.

Same day, evening & weekend appointments available. Complimentary transportation for MRI & CT Scans offered upon request.

Call 973-661-4674 today to schedule an appointment

Participating Insurances

  • Aetna (excluding Northern NJ Prime HMO)
  • Aetna Better Health & Dual Complete
  • Atlantic Imaging Group – AIG
  • Amerigroup
  • AmeriHealth
  • Atlantic Health (Qualcare)
  • Beech Street
  • Consumer Health Network – CHN
  • Cigna
  • Clover Health (Medicare)
  • Coventry
  • Department of Veteran Affairs
  • Devon
  • Empire BCBS (only local network)
  • Essex County Workers Comp
  • First Health
  • Government Employee Health Assoc. – GEHA
  • GHI/Emblem Health (PPO ONLY)
  • Great West
  • Health Network America
  • HealthNet Veterans Choice
  • HIP (PPO ONLY through Qualcare)
  • Horizon Blue Cross Blue Shield of NJ (Tier 1)
  • Horizon NJ Health and TotalCare
  • Humana/Choice Care (Qualcare) excluding Medicare
  • Local 825
  • Liberty Healthshare
  • Mail Handlers
  • Magnacare
  • Medicare
  • Multi Plan Network
  • New Jersey Manufacturers
  • OccuNet
  • One Call Medical
  • OSCAR (Qualcare)
  • Oxford
  • Prime Health Services
  • Private Healthcare Systems (PHCS)
  • Qualcare (all plans) (Tier 1)
  • United Healthcare (excluding Medicare Focus)
  • United Healthcare Community Plan of NJ ONLY
  • Wellcare
  • WTCHP-World Trade Center Health Plan
Amerigroup

Essex County Workers Comp.

Magnacare

DO YOU KNOW WHAT YOUR INSURANCE COST SHARE IS?

DO YOU KNOW WHAT YOUR INSURANCE OUT-OF-POCKET COSTS ARE?

DEDUCTIBLE

The amount you must pay for covered healthcare services before your health insurance kicks in.

Example: If Luke’s deductible is $2,000 his insurance won’t pay for anything until he has paid $2,000 for covered health care costs. If he requires hospitalization that costs $3,000, he would pay the $2,000 deductible, and the plan would pay for a portion of the remaining $1,000 (based on Luke’s plan specifics).

COINSURANCE

The percentage of the bill you pay for a covered product or service.

Example: Let’s sayTony visits his in-network doctor when he’s ill. He has already met his deductible, and his plan now requires a 20 percent coinsurance The cost of his insurance plan’s contracted rate is $150, he owes $30. His insurance company will pay the rest.

COPAYMENT

Set dollar amount you pay for a covered product or service.

Example: Sara has a $20 copay for visits with her primary care physician (PCP) and a $40 copay for urgent care visits. What does that mean? She will pay $20 for every doctor visit and $40 every time she goes to urgent care.

Most insurance plans require patient OUT-OF-POCKET costs for deductible, coinsurance and/or copayment.

Patients will be billed for all OUT-OF-POCKET costs after your insurance company has processed your claim.

Your insurance plan is a contract between you and your insurance company. If you want to know your coverage, please contact your insurance company.

SCREENING MAMMOGRAPHY – If criteria is met, there will be NO out-of-pocket cost

SCREENING BONE DENSITY – If criteria is met, there will be NO out-of-pocket cost

SCREENING BREAST ULTRASOUNDS – Out-of-pocket cost will be decided by your insurance company

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