Patient Information
For Patients
Important information about your fluoroscopy and X-ray services provided by Radiology Partners, LLC.
Who Is the Radiologic Technologist?
A Radiologic Technologist (RT) is a highly trained medical professional who specializes in performing diagnostic imaging examinations. During your surgical procedure, an RT from Radiology Partners, LLC will operate the C-arm fluoroscopy machine to provide your surgeon with real-time X-ray guidance.
Our RTs are credentialed by the American Registry of Radiologic Technologists (ARRT), hold California fluoroscopy permits, and are trained in radiation safety to ensure you receive the lowest possible dose while achieving the highest image quality.
Patient Consent
Fluoroscopy and X-Ray — Services and Charges
Radiology Partners, LLC (RPLLC) will be providing your fluoroscopy and/or X-ray services during your procedure. We are an independent company, separate from your physician and/or surgery center, and we bill your insurance directly for our services. Please carefully review the following information so we can address any questions or concerns you may have. We thank you for your trust and look forward to providing you with excellent radiology service!
Out-of-Network Notice – Commercial Insurance
Your rights under California law and the federal No Surprises Act:
You are receiving care at an in-network facility, but RPLLC is an out-of-network radiology provider.
- You will NOT be billed for the difference between our charges and your plan's payment (this is called 'balance billing' and is not allowed).
- You owe only your in-network cost-sharing (copay, deductible, coinsurance).
Medicare Patients
- RPLLC is a participating (in-network) Medicare provider.
- We bill Medicare directly and accept Medicare assignment.
- You are responsible only for the Medicare deductible and coinsurance, unless covered by another plan.
What to Expect After Your Procedure
You may receive an EOB from your insurance showing a higher amount billed; this is NOT a bill, and you will not owe the full amount shown. You are responsible only for in-network cost-sharing (copay, deductible, coinsurance).
Authorization and Assignment of Benefits
- I authorize RPLLC to bill my insurance/Medicare (including Workers' Compensation and/or attorney-related claims) and release necessary health and billing information to process or appeal claims.
- I assign all benefits payable for radiology services to RPLLC.
Acknowledgement
- I understand I am financially responsible only for in-network cost-sharing or Medicare-approved amounts.
- I understand I may receive an EOB from my insurance, but I do not owe the full charges shown on it.
- I understand my rights under California state and federal law (No Surprises Act).
Contact for Questions
By signing below, I acknowledge that I have read and understand this form, acknowledge my financial responsibility, authorize billing and assignment of benefits, and consent to receive fluoroscopy and/or X-ray imaging services from RPLLC.
Frequently Asked Questions
Common questions patients have about their imaging procedure.
Questions About Your Bill?
Our billing team is here to help. Reach out and we will walk you through your statement.
iconbilling@radiologypartners.net