Emory accepts most major insurance plans, including employer-based and private plans, federal health insurance marketplace plans, as well as traditional Medicare and Medicare Advantage plans. emory healthcare will submit a claim on your behalf to any third party or insurance company contracted with emory healthcare. any fees not paid by the third party or the insurance company are the responsibility of the patient.
A patient will receive a physician’s statement and a hospital statement for the difference between the amount their insurance company indicates is a liability and the amount of the deposit paid prior to service. payment is expected to be due within 30 days of receipt of statement. if a patient is unable to pay in full, they should contact 404-778-7318 for physician statements and 404-686-7041 for hospital statements.
- view accepted insurance plans
- carry your insurance card with you at all times
- understand your insurance benefits (this is your responsibility)
- make sure the doctor and facility are participating providers
- if necessary, do not schedule an appointment until an approved referral authorization is received
- Referral authorizations may have limited visits or expire; if additional visits are required, contact your pcp before returning to the specialist
Most managed care insurance companies, health maintenance organizations (hmos), or point-of-service (poss) plans require a referral or authorization from your primary care physician in order for you to see a specialist.
It is your responsibility to be familiar with your insurance coverage and whether or not your insurance company requires you to have a referral authorization. If your insurance company requires a referral authorization from your primary care physician, please notify your primary care physician and staff. If your insurance company requires a referral from a primary care physician and one was not obtained, you may be responsible for payment of services rendered.
usual and customary rates
Your insurance company may claim that your bill exceeds the usual and customary rates for a specific type of service. please understand there are no usual and customary fees. each insurance company determines how much it will reimburse for different medical services, and those rates vary widely. emory healthcare determines charges for your care based on knowledge of your treatment.
If all reasonable attempts to collect payment fail, emory healthcare reserves the right to use collection agencies or attorneys.
pay your bill
Payment for all services rendered is due at the time services are rendered. however, emory healthcare will submit a claim for you to any third party or insurance company contracted with emory healthcare. any fees not paid by the third party or the insurance company are the responsibility of the patient.
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contact your primary care physician (pcp) before seeing a specialist, if needed
insurance terms you should know
Premium: The amount you pay to your health plan each month to maintain coverage. network: The doctors, hospitals, and providers with whom your health insurer has contracted to provide health care services to its members. Contact your insurance company before making an appointment to confirm that Emory is in your network. charges: the amount billed to insurance companies and/or patients for services. allowed amount: The negotiated rate that your insurance company pays under contract for a covered medical service. emory does not balance bill patients and will not bill you for the difference between charges and the allowed amount. you are responsible for the portion of the allowed amount as defined by your benefit plan. Copayment – An amount you pay as your share of the cost of a medical service or item, usually applied to a doctor’s visit. deductible – The amount you owe for health care services before your health insurance or plan begins to pay. coinsurance – Your share of the cost of a covered health care service, usually calculated as a percentage (such as 20%) of the allowed amount for the service after you meet your deductible. out-of-pocket maximum: The most you must pay for covered services in a plan year. After you spend this amount on deductibles, copays, and coinsurance for in-network care and services, your health plan pays 100% of the costs for covered benefits.
A predetermination of benefits is a review by medical staff to decide if they agree that treatment is appropriate for the patient’s medical needs. predeterminations are made prior to scheduling care and include a review of medical necessity as well as the patient’s plan coverage.
precertification/prior authorization review of length of days
Precertification or prior authorization may be required before coverage is extended for certain procedures or high-cost prescription drugs. If prior approval is not given, an insurance company may deny payment. emory healthcare staff will contact your insurance carrier for precertification or prior authorization.
The time it takes for most common payers to review precertification or preauthorizations is shown below. if approval is not received within 48 hours of a procedure, and a patient is not considered medically urgent or emergent, services will be rescheduled. If you have any questions, please email the precertification department at [email protected]
Disclaimer: An authorization/referral is not a guarantee of insurance payment. member must be eligible at the time services are rendered. the services must be a covered health plan benefit and medically necessary according to the insurance plan’s policies and procedures.
emory healthcare partners with kaiser Permanente to offer collaborative integrated care.
federal health insurance marketplace (“the exchange”)
emory healthcare participates in many public federal exchange plans. Please call your insurance provider directly to confirm if you will be covered at emory and to clarify the coverage provided by your specific policy.
federal and state government programs (shampoo, medicare, medicaid)
if you are covered by one of the government programs, we will collect copays and deductibles at the time of service; remember to bring your insurance card. Whenever possible, emory hospitals and your emory doctor will also submit claims to your secondary insurer.