Elkhart Medical Organization FAQ's
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  600 East Boulevard
  Elkhart, Indiana 46514
  574-523-3436 (phone)
  800-543-3195
  574-523-7940 (fax)
Frequently Asked Questions
Q. I want to go to a practitioner or facility in Northeastern Indiana or Northern Ohio. Can I go to these providers in-network?
Some members using Elkhart Medical Organization as their provider network have access to additional providers, which may include Northeastern Indiana and Northern Ohio Medical Providers. Ask your Human Resources Department to contact their insurance agent or Elkhart Medical Organization for more details. Your Human Resources Department may contact us utilizing this web site or by calling 574-523-7914 or 800-543-3195.

Q. What is the status of my claim for medical benefits?
Look on your insurance card and find a phone number for the payor or the Third Party Administrator. Call that number during normal business hours and ask about the status of the claim in question.

Q. I already talked to the insurance company or payor - they told me to call you.
You may have called the payor to ask questions about your coverage, but first asked them if a certain provider was in network. They will immediately tell you to call EMO, as we have the information regarding who is in network and who is not. When you then call us and we answer your question regarding the provider's participation, you may need to know if certain procedures are covered. EMO will then ask you to call your payor, as they are the ones who know what your policy includes. We will also ask you to call your payor when the provider you have inquired about is not in network and you want to know what percent will be covered if you choose to go with that provider.

Q. I want to verify benefits.
   1. Reference your insurance plan book received from your employer.
   2. Call or go to your employer's human resource department and obtain benefit information.
   3. Call your payor, listed on your insurance card.

Q. Is a certain doctor in network?
Go to search providers to see if that doctor is in network. If not, you may choose from among three options:
   1. Find a network provider of the same specialty.
   2. Go to Suggest a Provider, fill in the information requested and send it to us.
   3. Choose to go to an out-of-network provider, which may cause you to pay more out of pocket.

Q. Is a certain facility in network?
Go to search facilities to see if that facility is in network. If not, you may choose from among three options:
   1. Find an in-network facility that can do the same procedure.
   2. Go to Suggest a Provider, fill in the information requested and send it to us.
   3. Choose to go to an out-of-network facility, choosing to pay more out of pocket.

Q. The facility is listed as in network - why is claim not covered?
Doctors and other practitioners act independently from the facilities. The doctors make independent decisions about entering into contracts; therefore the facility and any given practitioner may not be in the same network. Another scenario when this might occur is when the practitioner is in process of being credentialed and not active at the time services were rendered. Refer specific questions to EMO at 574-523-3436 or 800-543-3195, or click Customer Service.

Q. What percentage do I pay if my doctor or facilityis not in network?
Each benefit plan is written differently and we do not have that information. For an answer:
  1. Refer to your insurance plan book, received from your employer.
  2. Call or go to your employer's human resource department and obtain benefit information.
  3. Call your payor, listed on your insurance card.

Q. How can I get my practitioner or facility in EMO network?
Simply go to our Suggest a Provider Page. You may also e-mail Provider Relations with your request.

Q. Do I need to pre-certify my upcoming procedure?
Call the pre-certification number that is listed on your card. If there is no specific number for precertification, just call the number listed for the payor.


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