Accepted Insurances

Emory accepts most major insurance plans, including private and employer-based plans, Federal health insurance marketplace plans as well as traditional Medicare and Medicare Advantage plans. Emory Healthcare will submit a claim for you to any third party or insurance carrier with whom Emory Healthcare contracts. Any fees not paid by the third party or insurance carrier are the patient's responsibility.

A patient will receive a physician statement and a hospital statement for the difference between the amount their insurance company indicates is a responsibility and the amount of deposit paid prior to service. Payment due is expected within 30 days of receiving the statement. If a patient is unable to pay in full, they should contact 404-778-7318 about physician statements and 404-686-7041 about hospital statements.

Insurance Terms to Know

Premium – The amount you pay your health plan each month to maintain coverage.

Network – The doctors, hospitals, and suppliers your health insurer has contracted with to deliver health care services to their members. Please contact your insurance company before scheduling 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 your insurance company contractually pays for a covered medical service. Emory does not balance bill patients and will not bill you for the difference between the charges and the allowed amount. You are responsible for the portion of the allowed amount as defined by your benefit plan.

Co-payment – An amount you pay as your share of the cost for a medical service or item, typically applied to a doctor's visit.

Deductible – The amount you owe for covered health care services before your health insurance or plan begins to pay.

Coinsurance – Your share of the cost for a covered health care service, usually calculated as a percentage (like 20%) of the allowed amount for the service after your deductible is met.

Maximum Out of Pocket – The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, co-payments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.

Predetermination

A predetermination of benefits is a review by medical staff to decide if they agree that the treatment is right for the patient’s medical needs. Predeterminations are done before care is scheduled and include a review for medical necessity as well as coverage under the patient’s plan.

Precertification/Prior Authoriziation
Length of Days Review

Precertification and 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 carrier may deny payment. Emory Healthcare staff will contact your insurance company to obtain precertification or prior authorization.

Below is the length of time most common payers take to review precertification or prior authorizations. If approval is not received within 48 hours of a procedure, and a patient is not deemed medically urgent or emergent, services will be rescheduled. If you have any questions, please email the Precertification Department at ehcprecert@emoryhealthcare.org.

Payer Radiology Surgery
Aetna 14 days 15 days
BCBS 5 days 15 days
Cigna 14 days 15 days
Humana 5 days 7-14 days
Kaiser 14 days 14 days
Medicaid 14 days 10 days
Tricare 7 days 7 days

Disclaimer: An authorization/referral is not a guarantee of insurance payment. Member must be eligible at the time services are rendered. Services must be a covered health plan benefit and medically necessary per insurance plan policies and procedures.

Federal Health Insurance Marketplace ("The Exchange")

Emory Healthcare participates in many public federal exchange plans. Please call your insurance provider directly to confirm whether you will be covered at Emory and to clarify the coverage provided by your specific policy.

Federal and State Government Programs (Champus, Medicare, Medicaid)

If you are covered by one of the governmental programs, we will collect co-pays and deductibles at the time of service — please remember to bring your insurance card. Whenever possible, Emory Hospitals and your Emory physician will submit claims to your secondary insurance carrier as well.

Your Responsibilities

  • Carry your insurance card with you at all times
  • Understand your insurance benefits (this is your responsibility)
  • Ensure the physician and health center are participating providers

Contact your primary care physician (PCP) prior to seeing a specialist, if required

  • If required, do not schedule an appointment until an approved referral authorization is received
  • Referral authorizations may have limited visits and/or expire – if additional visits are required, contact your PCP prior to going back to the specialist

Referral

Most managed care insurance companies, Health Maintenance Organizations (HMOs) or Point of Service plans (POSs) require a referral or authorization from your primary care physician for you to see a specialist.

It is your responsibility to be familiar with your insurance coverage and know whether or not your insurance carrier requires you to have a referral authorization. If your insurance carrier does require a referral authorization from your primary care physician, please let your primary care physician and staff know. If your insurance carrier requires a primary care physician referral and one was not obtained, you may be responsible for payment of services rendered.

Usual and Customary Rates

Your insurance carrier 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 rates. Each insurance company determines how much it will reimburse for different medical services, and those rates vary widely. Emory Healthcare determines the charges for your care based on knowledge of your treatment.

Collection

If all reasonable attempts of collecting payment fail, Emory Healthcare reserves the right to use the service of collection agencies or attorneys.

Paying Your Bill

Payment for all services provided is due at the time services are rendered. However, Emory Healthcare will submit a claim for you to any third party or insurance carrier with whom Emory Healthcare contracts. Any fees not paid by the third party or insurance carrier are the patient's responsibility.