Estimating out of pocket expenses

All fees for procedures and services are disclosed to you prior to your appointment. We also do our best to help you estimate what your insurance coverage might be if you have out of network benefits. If you have any coverage, we can assist with submitting the claim to your insurance company on your behalf, so that you can receive your benefits according to your plan.

For certain services, we request payment upfront and we will submit a claim for you to be reimbursed directly by your insurance company. In other instances, you will not be asked to pay the full amount upfront and we will submit the claim to your insurance company first. Once we have received payment from them, you will receive a balance bill for the portion that they have not covered.

The amount the insurance will cover typically depends on your insurance plan’s:

  • Allowed Rate (how much the plan pays an out of network provider for a specific service)
  • Deductible (how much you pay before your insurance plan starts to cover services)
  • Co-Insurance (the percent you are responsible for once you have met your deductible)
  • Out-of-Pocket Maximum

If you have met your out of network deductible, you would be responsible for your co-insurance on the allowed rate, and if you have met your out-of-pocket maximum, you should no longer be responsible for paying any co-insurance. If Dr. Kumar’s fee is more than the allowed rate, you would also be balance-billed for the difference between the her fee and the allowed rate.