Atlas Infectious Disease Practice works with many health insurance plans. We strive to keep this list up to date, but insurance plans can change their coverage. It is always a good idea to double-check your insurance company about your specific plan and what it covers. They can give you the most current information about which doctors, services, and procedures are included.
Some health plans require referrals or prior authorization before you receive services from health care providers other than your primary care provider (PCP). A referral is an order from your PCP to see our Infectious Disease Physicians or receive certain medical services from our doctors. Your PCP helps make the decision about whether our specialist services are necessary for you.
Prior authorization is approval from the health plan before you get a service or fill a prescription. The health plan reviews medical records from your providers and decides whether the service or prescription drug meets the plan’s rules for medical necessity.
Here’s why this matter: Without obtaining required referrals or prior authorizations, you might be responsible for the full cost of your medical care.
Remember, referral policies can vary by insurance plan. Always verify your plan’s specific requirements with your insurance provider or PCP’s office.
If you do not see your plan or network on our list, do not worry! Contact your insurance company directly. They can tell you if Atlas Infectious Disease Practice is covered under your plan and what services might be included. You can usually find their member services phone number on your insurance card.
Medical insurance helps individuals, families, and small businesses pay for medical expenses. It covers costs associated with various healthcare services, including doctor’s visits, hospital stays, surgery, and prescription drugs.
There are several types of medical insurance plans available, including:
Employer-sponsored health insurance: This type of insurance is offered by employers to their employees. In this scenario, the employer usually covers a portion of the insurance premium, while the employee pays the rest.
Commercial plans: These plans are either employer-sponsored or privately purchased. Examples of companies offering commercial plans include Aetna, Cigna, and Humana
Exchange plans: Also referred to as Health Insurance Marketplace®, exchange plans assist individuals, families, and small businesses in finding suitable health insurance coverage.
Medicaid plans: This is a public health insurance program for low-income individuals and families, including children, pregnant women, seniors, and people with disabilities.
Medicare Advantage Plans: This is a federal health insurance program primarily for people aged 65 and older, as well as certain younger individuals with disabilities or kidney failure.
Medicare + Medicaid dual plans: These plans combine the coverage offered by both Medicare and Medicaid6.
Copayment: A fixed amount you pay for a covered health care service, usually when you receive the service.
Deductible: The amount you pay for covered health care services before your insurance plan starts to pay.
Coinsurance: Your share of the costs of a covered health care service, calculated as a percentage of the allowed amount for the service.
Out-of-pocket maximum: The most you pay during a policy period before your health insurance or plan begins to pay 100% of the allowed amount.
Understanding health insurance referral and prior authorization
It is crucial to verify your insurance coverage before seeking medical care. Here are steps to check your coverage:
Gather all necessary information: Have your insurance card and relevant documents handy, including your policy number, group number, and the name of your insurance company.
Contact your insurance company: Call the customer service number on your insurance card or visit the company’s website to verify your coverage.
Check your coverage online: Many insurance companies have member portals on their websites where you can log in and view your coverage details.
Contact your employer: For employer-sponsored insurance, your HR department can assist in verifying coverage for counseling and outpatient office visits.
Consult your insurance plan documents: Review your policy documents, which outline coverage details, including exclusions and limitations.
Remember, understanding your medical insurance plan is vital for managing healthcare costs and making informed decisions about your care.
