Patients

Upload Your Script

Step One

Our online script upload form allows us to ensure we have a copy of your prescription prior to your appointment. This save our staff and importantly, you, time when checking in at any of our offices. Lake Zurich Open MRI is able to match your script upload to the correct imaging study ordered by your physician.

Simply upload a scan or photograph of your script from your physician before your visit. We accept the following formats: .PDF, .JPEG, or . PNG.

Step Two

Please fill out the information on the form, click on “Choose File” to select the appropriate file on your device, and then press “Submit” once you are finished to securely send this information to us.

Patient Rights

Each patient receiving services in an ambulatory care facility shall have the following rights:

To be informed of these rights, as evidenced by the patient’s written acknowledgment, or by documentation by staff in the medical record, that the patient was notified that a written copy of these rights and a written or verbal explanation of these rights, in terms the patient could understand is available upon request. The facility shall have a means to notify patients of any rules and regulations it has adopted governing patient conduct in the
facility.
To be informed of services available in the facility, of the names and professional status of the personnel providing and/or responsible for the patient’s care, and of fees and related charges, including the payment, fee, deposit, and refund policy of the facility and any charges for services not covered by sources of third-party payment or not covered by the facility’s basic rate;
To be informed if the facility has authorized other health care and educational institutions to participate in the patient’s treatment. The patient also shall have a right to know the identity and function of these institutions and to refuse to allow their participation in the patient’s treatment;
To receive from the patient’s physician(s) or clinical practitioner(s), in terms that the patient understands, an explanation of his or her complete medical/health condition or diagnosis, recommended treatment, treatment options, including the option of no treatment, risk(s) of treatment, and expected result(s). If this information would be detrimental to the patient’s health, or if the patient cannot understand the information, the explanation shall be provided to the patient’s next of kin or guardian. This release of information to the next of kin or guardian, along with the reason for not informing the patient directly, shall be documented in the patient’s medical record.
To participate in the planning of the patient’s care and treatment, and to refuse medication and treatment. Such refusal shall be documented in the patient’s medical record. Note that Lake Zurich Open MRI Imaging Center does not honour Advanced Directives.
To be included in experimental research only when the patient gives informed, written consent to such participation or when a guardian gives such consent for an incompetent patient in accordance with law, rule, and regulation. The patient may refuse to participate in experimental research, including the investigation of new drugs and medical devices.
To voice grievances or recommend changes in policies and services to facility personnel, the governing authority, and/or outside representatives of the patient’s choice either individually or as a group, and free from restraint, interference, coercion, discrimination or reprisal.
To be free from mental and physical abuse, free from exploitation, and free from use of restraints unless they are authorized by a physician for a limited period of time to protect the patient or others from injury. Drugs and other medications shall not be used for discipline of patients or for convenience of facility personnel;
To confidential treatment of information about the patient. Information in the patient’s medical record shall not be released to anyone outside the facility without the patient’s approval, unless another healthcare facility to which the patient was transferred requires the information, or unless the release of the information is required and permitted by law, a third-party payment contract, or a peer review, or unless the information is needed by the Illinois State Department of Health for statutorily authorized purposes. The facility may release data about the patient for studies containing aggregated statistics when the patient’s identity is masked;
To be treated with courtesy, consideration, respect, and recognition of the patient’s dignity, individuality, and right to privacy, including, but not limited to, auditory and visual privacy. The patient’s privacy shall also be respected when facility personnel are discussing the patient;
To not be required to perform work for the facility unless the work is part of the patient’s treatment and is performed voluntarily by the patient. Such work shall be in accordance with local, State, and Federal laws and rules;
To exercise civil and religious liberties, including the right to independent personal decisions. No religious beliefs or practices, or any attendance at religious services, shall be imposed upon any patient; and
To not be discriminated against because of age, race, religion, sex, nationality, or ability to pay or deprived of any constitutional, civil, and/or legal rights solely because of receiving services from the facility.
To expect and receive appropriate assessment, management, and treatment of pain as an integral component of that person’s care in accordance with NJAC 8:43 E-6.

GOOD FAITH ESTIMATE DISCLOSURE FOR UNINSURED/SELF-PAY PATIENTS

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.

You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the healthcare provider or facility gives you a Good Faith Estimate in writing within 3business days after you ask.
If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
Make sure to save a copy or picture of your Good Faith Estimate and the bill.

For questions or more information about your right to a Good Faith Estimate, visit the Centers For Medicare & Medicaid website

Discrimination is Against the Law

Lake Zurich Open MRI complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Lake Zurich Open MRI Imaging Center does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Lake Zurich Open MRI:

Provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreters
- Written information in other formats
Provides free language services to people whose primary language is not English, such as:
- Qualified interpreters (Spanish)
- Information written in other languages.

If you need these services, contact your Lake Zurich Open MRI Manager.

If you believe that Lake Zurich Open MRI has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

Compliance Department
Email: info@lakezurichopenmri.com
Phone: (847) 726-0674

You can file a grievance in person or by mail, fax, email, or online. If you need help filing a grievance, our facility manager is available to help you.

YOUR RIGHTS AND PROTECTIONS AGAINST SURPRISE MEDICAL BILLS

You are protected from balance billing when you receive emergency care or are treated by an out-of-network healthcare provider at an in-network hospital or ambulatory surgical center. In these instances, you shouldn’t be charged more than your insurance plan’s copayments, coinsurance, and deductible.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copay, coinsurance, or a deductible. You may have additional charges or pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the total amount charged for a service. This is called “balance billing.” This amount is likely more than the in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care–like when you have an emergency or schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could amount to thousands of dollars depending on your services.

You are protected from balance billing for:

Emergency services

Suppose you have an emergency medical condition and get emergency services from an out-of-network provider or facility. In that case, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balanced billed for these emergency services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers may be out-of-network. In these cases, the most those providers may bill you is your insurance plan’s in-network cost-sharing amount. This applies to emergency medicine, anaesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections to be balanced billed.

If you get other services at these in‐network facilities, out‐of‐network providers can’t balance bill you unless you give written consent and give up your protections.

You’re never required to give up your protection from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have these protections:

You’re only responsible for paying your share of the cost (the copayments, coinsurance, and deductible that you would pay if the provider or facility were in‐network). Your health plan will pay additional costs directly to out‐of‐network providers and facilities.

Generally, your health plan must:

Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
Cover emergency services by out‐of‐network providers.
Base what you owe the provider or facility (cost‐sharing) on what it would pay an in‐network provider or facility and show that amount in your explanation of benefits.
Count any amount you pay for emergency services or out‐of‐network services toward your in‐network deductible and out‐of‐pocket limit.

If you think you’ve been wrongly billed, contact the Department of Health and Human Services (HHS) at 1-800-985-3059. Visit Centers for Medicare & Medicaid Services for more information about your rights under federal law.

FAQs

How do I schedule an MRI Scan?

Before visiting our MRI imaging center, you will need to schedule an appointment by either calling or filling out our contact form. Our patient representatives will ask for the following information:

Physician referral or prescription
The reason for the MRI scan
The body part being scanned
Insurance Card
Government Issued I.D.

Self-referrals are allowed. You can request an MRI scan without a referral or prescription. Our patient representative will ask safety questions and the reason for your request before scheduling your MRI appointment.

How long is an MRI Scan?

The length of an MRI scan depends on what part of the body is being studied. On average, an MRI scan takes about 15 – 90 minutes. The results of the MRI scan will be interpreted by a subspecialized radiologist and sent to your physician within 48 hours.

How do I prepare for an MRI Scan?

An MRI scan requires little to no special preparation. Larchmont Medical Imaging recommends that you wear comfortable, loose-fitting clothing. You should avoid wearing any accessories that contain metal including zippers, buttons, jewelry, underwire, and so forth. Based on the part of the body being scanned, your physician and our staff may instruct you to fast prior to your appointment.

Does Insurance Cover an MRI Scan?

Lake Zurich Open MRI is in-network with 99% of health insurance providers. If your MRI imaging study is not covered by your insurance, our team will work with you and your family to determine the best action to take. Please contact your insurance carrier to inquire about our in-network status if you don’t see your plan listed.

What can I do if I am anxious or nervous for an exam?

What does an MRI detect?

An MRI scan can detect medical abnormalities across different areas of the body. In comparison to a CT scan, MRIs produce more precise results without the use of radiation. Commonly, physicians use an MRI imaging study to help diagnose conditions such as:

Blood vessel abnormalities
Gastrointestinal conditions
Heart problems
Joint injuries
Pancreatic conditions
Traumatic brain injuries or strokes

Schedule Your MRI Scan Today

Call us at 1(847) 726-0674 or use our easy online appointment form below.

Lake Zurich Open MRI Imaging & Diagnostic Center understands how the delivery of expert diagnostic insights shapes the patient and physician experience. With over 20 subspecialized radiologists, our outpatient imaging centers perform and interpret the most advanced MRI imaging studies to ensure our patients and physicians receive the answers they need.