Insurance Information

Your Responsibilities:

  • Make sure you have your current insurance card with you at all times.
  • Be familiar with your insurance benefits. It is the patient's responsibility to know the insurance carrier's requirements and procedures.
  • Make sure your physician and the health center are listed as a participating provider in your plan's provider book.
  • If your insurance carrier requires a referral authorization, contact your primary care physician prior to seeing a specialist.
  • Do not schedule an appointment with a specialist until your primary care physician obtains a referral authorization from your insurance company.
  • Be aware that most referral authorizations are good for a certain number of visits and have an expiration date. If your specialist requires more visits than your specified amount or if the date of the visit has expired, it is your responsibility to contact your primary care physician prior to going back to the specialist.

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. The charges for your care are based on knowledge of your treatment.

Collection

If all reasonable attempts of collecting payment fail, Emory-The Doctor's Office reserves the right to use the service of collection agencies or attorneys.

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.

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