DeKalb Medical accepts most insurance plans, provided we receive proof of coverage. Once we have verified your insurance, a claim is issued for total charges. Your insurance company calculates the payment amount and pays us accordingly. In addition to this payment, your insurance company provides us with an explanation of benefits and your required amount.
If you are covered by more than one policy, we will process the claims for all companies. If there’s an overpayment on your account, we will make a refund within the time allowed by Georgia law for such transactions, to the appropriate party.
Please remember that your insurance policy is a contract between you and your insurance company. We will do our very best to see that you receive all the benefits to which you are entitled, but you are ultimately responsible for the payment of your account.
Most insurance companies now require pre-certification for elective admissions and procedures. In other words, your stay must be determined to be medically necessary by your plan prior to your admission to the hospital. Only medically necessary services are deemed covered and payable by insurance carriers. If you are admitted without the necessary pre-certification, your insurance company could refuse to pay all or part of your hospital bill. Some plans require that certain surgical procedures be done on an outpatient basis. If you are unsure about these requirements, discuss them with your physician, your employers and your insurance company before you are admitted to the hospital.
Based on your insurance provider, we ask that you provide the following information when you are admitted.
Group Insurance (HMO, PPO, Indemnity and insurance purchased through the government exchange) – the mailing address for the claim and a copy of your current insurance card.
Individual Insurance – Acceptance of this type of insurance is based on your type of policy. Please speak with our Admissions Department prior to your admission.
Medicare and Medicaid – If you are a Medicare patient, we will need your Medicare card. If you are a Medicaid patient, please bring your current month’s Medicaid form.
Workers’ Compensation – Please provide the name, address and phone number of the employer, the name of the insurance company that will pay for your "on the job" injury, and the name and phone number of the contact person for authorization.
Active or Retired Military – Please bring your military ID card. Any dependent patient 10 years or age or older must present an ID card.