Insurance Information

Accepted Insurances

Emory Healthcare accepts most major insurance carriers, public federal exchange plans, as well as many Federal and State Government Programs. Accepted insurance may vary slightly among practices. Please check with your Emory Healthcare Network physician’s office or your insurance carrier to verify coverage before your appointment.

About 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.

About 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 Authorizations

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.

Pay 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.