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.
Where Can I Find A Doctor That Accepts Medicare And Medicaid
To find a doctor that accepts Medicare payments, you may want to visit the Centers for Medicare and Medicaid Services’ Physician Compare. You can search by entering a health care professionals last name or group practice name, a medical specialty, a medical condition, a body part, or an organ system. This tool will provide you with a list of professionals or group practices in the specialty and geographic area you specify, along with detailed profiles, maps and driving directions.
Please note that Physician Compare only lists professionals that accept Medicare. Although some may also accept Medicaid, it does not have information about which professionals do accept Medicaid.
Medicaid programs vary by state and each state Medicaid agency maintains their own list of professionals that accept Medicaid. For further assistance, please contact your health plan or state Medicaid agency. For more information about Medicaid, visit the Medicaid & CHIP page on Healthcare.gov.
If you have trouble accessing the Physician Compare website, please call 1-800-MEDICARE and a representative will be able to run the search for you. They can also send you a print version of the search results.
There are other directories on MedlinePlus that will help you find health professionals, services, and facilities, some of which may serve Medicare or Medicaid payments.
Georgia Has Not Accepted Federal Medicaid Expansion
- 2,195,640 Number of Georgians covered by Medicaid/CHIP as of July 2021
- 678,000 Number of additional Georgia residents who would be covered if the state accepted expansion
- 269,000 Number of people who have NO realistic access to health insurance without Medicaid expansion
- $3.5 billion Federal money Georgia is leaving on the table in 2022 by not expanding Medicaid
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How Can I Book An Appointment Online With A Medicaid Eye Doctor In Atlanta
Zocdoc is a free online service that helps patients find Medicaid Eye Doctors in Atlanta and book appointments instantly. You can search for Medicaid Eye Doctors in Atlanta by symptom or visit reason. Based on that information, youll see a list of providers who meet your search criteria, along with their available appointment slots.
Caresource24 Nurse Advice Line
CareSource24 provides around-the-clock access to a caring and experienced staff of registered nurses.
Our nurses can help you:
- Understand a medical condition or recent diagnosis
- Find out more about prescriptions or over-the-counter medicines
You can call CareSource24 toll-free 24 hours a day, 7 days a week, 365 days a year at: 1-844-206-5944 . The number is also on your CareSource member ID card.
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Are Video Visits With An Eye Doctor Online Covered By Medicaid
Most insurers provide coverage for video visits at the same cost as in-person visits. You can search on Zocdoc specifically for Eye Doctors in Atlanta who accept Medicaid for video visits by selecting your carrier and plan from the drop-down menu at the top of the page. We recommend you check with your insurance carrier directly to confirm your coverage and out of pocket costs for video visits.
Convenience Care Clinics And Urgent Care Centers
The CareSource network includes urgent care centers and retail health clinics inside drug and grocery stores to help you get care when and where you need it. These clinics often have evening and weekend hours and allow walk-ins. You can find these network providers through our Find a Doctor/Provider tool.
Urgent care is for non-emergencies. They are for when you cant see your PCP right away. They help keep an injury, sickness, or mental health issue from getting worse. If you think you need to go to urgent care, you can:
- Go to a network urgent care center listed in our our Find a Doctor/Provider tool
After you go, always call your PCP to schedule follow-up care.
When you are outside the service area, you might not be able to get care from a network provider. In that case, our plan will cover urgently needed care you get from any provider within the United States or its territories.
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Who Is Eligible For Medicaid In Georgia
As of April 2020, criteria for enrollment in Georgia Medicaid are set at the following levels for non-disabled adults :
- Children up to age 1 with family income up to 210% of federal poverty level
- Children ages 1-5 with family income up to 154% of FPL
- Children ages 6-18 with family income up to 138% of FPL
- Pregnant women with family income up to 225% of FPL
- Parents of minor children with family income up to 36% of FPL
Georgia Pathways Would Be Costly For The State And Complicated For Enrollees
Although Georgia Pathways is currently on hold due to the legal dispute over the work requirement and premiums, it could still be implemented at a later date. Lets take a look at what the state wants to do in terms of partial Medicaid expansion.
As part of the waiver proposal, Georgia asked CMS to provide the state with full Medicaid expansion funding , despite the fact that the state would only be implementing a partial expansion of Medicaid. A similar request from Utah was rejected by the Trump administration in 2019, and CMS followed the same process for Georgia: The federal government will not provide the 90% funding match for Georgias partial Medicaid expansion, but will instead pay the states normal federal matching rate of 67%. This means it will cost Georgia more to cover the expanded Medicaid population than it would if the state were to simply expand Medicaid fully, as called for in the ACA.
Under the Georgia Pathways program, enrollees must report their community engagement on a monthly basis. But if they comply with the community engagement requirement for at least six consecutive months, theyll be exempt from the reporting requirement and will only have to report changes, if applicable. Eligibility will continue to be redetermined annually.
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How Can I Find A Top
You can use Zocdoc to find Medicaid Eye Doctors in Atlanta who are highly rated by other patients. These ratings are based on verified reviews submitted by real patients. Every time a patient completes an appointment booked on Zocdoc, theyre invited to review their experience. Each review must comply with Zocdocs guidelines.
Georgias History With Medicaid Expansion
As of May 2020, 23% of Georgia residents were uninsured the state had the fourth-highest uninsured rate in the U.S. at that point. Georgia is leaving billions of dollars on the table and over half a million people without Medicaid coverage by passing up federal funding to expand Medicaid.
Two laws designed to make expansion difficult were enacted during the 2014 legislative session in Georgia. HB 990 prohibits Medicaid expansion without legislative approval , while HB 943 prohibits state and local employees from advocating for Medicaid expansion.
By the spring of 2016, Medicaid expansion began to seem within reach in Georgia, fueled in part by support from hospitals facing severe financial challenges. The state has raised Medicaid reimbursement rates for providers, including OB-GYNs in the state, in an effort to keep providers solvent and able to accept Medicaid patients. And Republican lawmakers began indicating that they might be open to a privatized version of Medicaid expansion, like the model used in Arkansas.
However, there was no real progress on Medicaid expansion in Georgia until the partial expansion proposal was announced in 2019. Governor Brian Kemp, who took office in 2019, has been steadfastly opposed to full Medicaid expansion, although he views the Georgia Pathways program as a conservative compromise aimed at helping people who are working but not able to afford health coverage.
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For Members In Medicaid Or Peachcare For Kids
Georgia Families gives you choices for your health care! Choose a health plan and a Primary Care Provider for each member in your family who is in Medicaid or PeachCare for Kids®.
Alert: Due to COVID-19 restrictions, in person visits are not currently available.
As soon as you become a member of Medicaid or PeachCare for Kids® you will be enrolled into a health plan. If you do not want the health plan we chose for you, you can change to another health plan. You will have 90 days from the start date of your health plan to change. You can change your health plan in one of these three ways:
Learn more about:
- Contacts: Georgia Families, Medicaid, PeachCare for Kids®, Family & Children Services offices, health plans
Federal And State Government Programs
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.
- Carry your insurance card with you at all times
- Understand your insurance benefits
- Ensure the physician and health center are participating providers
Contact your primary care physician 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
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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 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.
Your Primary Care Provider
Each CareSource member has a primary care provider . Your PCP is a doctor, group practice, advanced practice nurse or advanced practice nurse group practice trained in family medicine , internal medicine or pediatrics. Your PCP will:
- Work with you to direct your health care
- Treat you for most of your health needs
- Send you to a specialist, if needed
- Admit you to the hospital
Going to the same PCP each time you need care will help your PCP get to know you and your needs. The better your PCP get to know you and your medical history, the better your PCP will be able to treat you.
If you havent chosen a PCP yet, you can call Member Services or log on to MyCareSource to find one. If you are a new patient for your PCP, you should call to schedule a visit. This will help your PCP get to know your health needs right away. You should go for your first visit within 90 days of joining CareSource.
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How Can I Make A Same
On average, patients who use Zocdoc can search for an Eye Doctor in Atlanta who takes Medicaid insurance, book an appointment, and see the Eye Doctor within 24 hours. Same-day appointments are often available, you can search for real-time availability of Eye Doctors in Atlanta who accept Medicaid insurance and make an appointment online.
How Does Medicaid Provide Financial Help To Medicare Beneficiaries In Georgia
Many Medicare beneficiaries receive assistance from Medicaid with Medicare premiums, prescription drug costs, and expenses not covered by Medicare including long-term care.
Our guide to financial assistance for Medicare enrollees in Georgia includes overviews of these programs, including Medicaid nursing home benefits, Extra Help, and eligibility guidelines for assistance.
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National Experience Local Impact
Aetna Better Health is proud to be part of the CVS Health® family. Together, we share a vision to be a trusted health partner in the local communities we serve. We go beyond offering a traditional medical approach by providing a full array of services that enhance overall wellness and improve everyday life. Because our goal is to build a better health experience thats responsive to the needs of our members.
We invite you to explore all Aetna Better Health has to offer and see how our national experience comes to life at the local level.
Precertification/prior Authorizationlength 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 .
| Payer | |
| 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.
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