Insurance Information

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.

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.

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.

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.

• 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

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 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.