Outpatient diagnostic testing performed within a hospital setting for reasons that do not involve an emergency or one of the other exceptions listed under the diagnostic testing provision of the Plan, will be paid as an out of network claim. This means that, participants will be responsible for any balance billing. This would include those facility claims that are billed under the tax-identification number of a hospital. To avoid any possible balance billing you should utilize a participating free standing diagnostic testing facility (Non-hospital related), whenever you require diagnostic testing.
Please reference the Welfare Fund Summary Plan Description Book for more detailed information.