Insurance Accepted
Insurance and Financial Eligibility
At Kaufman Allergy Asthma and Immunology, PLLC we understand that insurance plans can vary widely – even within the same insurance company. Many newer or limited-network plans have closed panels or no out-of-network benefits, which can create confusion for patients seeking specialty care.
Because of this complexity, we no longer maintain a list of in-network plans on our website. Instead, we encourage all patients to check directly with their insurance company to confirm their out-of-pocket responsibilities prior to scheduling.
If the plan requires a referral or preauthorization, it is the patient’s responsibility to ensure that documentation is obtained and on file with our office prior to each appointment. If required documentation has not been obtained prior to services being provided, the cost will likely not be covered by your insurance plan and will be the patient’s financial responsibility.
Understanding the details of insurance coverage is essential, including the insurance plan’s requirements for referrals, payment of a deductible, co-insurance, and/or co-payments.
Prior to scheduling Telehealth visits, we do ask that our patients verify that Telehealth is a covered service with their health insurance plan, and sign our Telehealth consent form.
Out of Network?
You are welcome to see us as a self-pay patient at our transparent cash pay pricing. After your visit, you may submit an itemized receipt to your insurance plan if you have out-of-network benefits. Reimbursement depends entirely on your individual policy and is not guaranteed. Many restrictive plans do not allow out of network benefits, and the cost of services will be the responsibility of the patient.
If you have questions about your specific plan, our team is happy to guide you through what to ask your insurance provider before your visit, though it is your responsibility to communicate with your insurance provider regarding these issues.
Understanding Your Health Insurance
Allowed Amount – The maximum amount on which payment is based for covered health services
Co-insurance – Your share of the costs of a covered heath service, calculated as a percent of the allowed amount for the service. You pay co-insurance plus any deductibles you owe.
Co-payment – A fixed amount you pay for a covered health care service, usually paid at the time when you receive the service. The amount can vary by the type of covered health service.
Deductible – The amount you owe for health care services your health insurance plan covers before your health insurance plan begins to pay. The deductible may not apply to all services.
Out-of-Pocket Limit – The most you pay during a policy period (usually a year) before your health insurance plan begins to pay 100% of the allowed amount. This limit never includes your premium or health care services that your plan doesn’t cover. Some health insurance plans don’t count all of your co-payments, deductibles, co-insurance payments, out-of-network payments or other expenses toward this limit.