Participating Insurance

Imaging Fees

Partial listing of imaging procedures RMRI performs with associated fees

For Patients

Financial Responsibility

Patient Forms

For your convenience, we’ve made pre-admission forms available. If you wish, you may print these forms and fill them out before your office visit in an effore to decrease any wait time.

Advance Beneficiary Notice Financial Responsibility
Patient Information Release MRI Evaluation

Registration and Billing

Upon arrival, patients are asked to register at the reception desk. A receptionist will ask for insurance cards and driver’s license or similar proof of identification. All patients will be asked to review a financial responsibility form and sign. The receptionist will begin your registration process immediately upon your arrival. Generally the process may take a few minutes to complete. Afterwards the technologist will meet you to begin the procedure.

When the procedure is over the technologist will escort you to the waiting room so you may leave. In most cases we will bill you for any uncovered portion of service. This will include deductibles or co-pays required by your insurance. We often have no knowledge of the amount prior to receiving an explanation of benefits from your insurance plan. Your financial responsibility is determined by your insurance plan, not by us. If you are responsible for any portion of your service you will be billed later, generally within 30 to 60 days.

Insurance Coverage

As a patient and subscriber to a Health Insurance Plan, it is important you understand
the healthcare provider’s relationship is with you and not your insurance company.

It is your responsibility to be aware of your insurance coverage, policy provisions, exclusions and limitations as well as preauthorization requirements. This information is furnished by the insurance carrier.

If your coverage is not in effect at the time of your visit, the financial responsibility for payment is yours.

If there are any changes in your insurance coverage, you must notify us.

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Insurance Payments

Deductibles are the patient’s responsibility. The deductible is determined by the contract you have with your insurance carrier. We do not know how much each person’s deductible is and how much has been met at the time of your visit.

Co-payments and co-insurance are the patient’s responsibility.

Unless specifically prohibited by our agreement with your carrier, all patients are responsible for “non-covered” services if denied by their insurance carrier.


It is your responsibility to obtain referrals if required to do so by your plan.

Insurance Requests

It is important that you respond to any request from your insurance carrier for additional information. Not doing so could result in a claim denial and you will be responsible for payment.

Insurance Payments Sent to You

If insurance payments are sent to you, you are responsible for forwarding them to our office with a copy of the explanation of Benefits (EOB) received otherwise, the service will remain unpaid and could result in transfer to a collection agency for follow-up. Please forward payment as soon as possible to avoid any inconvenience.

Insufficient Funds

There will be a $30.00 charge if your check is returned for non-payment by your bank.

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