600 East Boulevard
Elkhart, Indiana 46514
How does EMO control healthcare costs?
The physicians and other healthcare providers who are part of the EMO network have agreed to offer services to EMO members on a discounted basis. They can do this because of the number of members that an employer brings into the plan. That's why it's important that when you need care, you go to one of the providers in our network whenever possible. You may use an "out-of-network" provider that is not part of EMO, but when you do your benefits may be limited and your out of pocket expenses could be greater.
As an EMO member, there are important things to keep in mind when going to the doctor or other healthcare provider or facility:
- Know your out of pocket expenses.
Know what deductibles, co-pays, and coinsurance obligations you are responsible for. These may vary for different kinds of provider visits. If you're unclear, ask your employer or call the payor number listed on the back of your EMO member card.
- Carry your current EMO member card at all times.
Make sure you're carrying your current EMO member card, and give it to your medical provider so they can make a copy for their files each time you go for services.
- Pay your share at the time of service.
Be prepared to pay your co-pay and all non-covered services at the time of your visit. If you're not sure if a particular service will be covered, ask your employer or call the payor number listed on the back of your EMO member card.
- Check on referrals.
If you are referred to another provider (for example, if your family doctor sends you to a specialist) check to see if this provider is part of the EMO network. If not, ask your doctor if it is possible to be referred to an EMO provider. You will likely incur additional costs if the provider is not part of the network. It is the member's responsibility to confirm that they are sent to in-network providers.
Click here for a listing of EMO network providers. Another way to confirm if a provider is in-network is to call the customer service representative.
- Obtain pre-certification when necessary.
Many medical procedures, such as out-patient surgery, may require pre-certification prior to receiving care. It is your responsibility to get this pre-certification if necessary, and failure to do so can result in financial penalties. To get pre-certification, call the "UM" or "UR" number on the back of your card. Tell the person who answers what procedures were ordered, by whom, and when and where the procedure will be done.