At Kaufman Health and Hormone Center, we are committed to making your healthcare experience as smooth and seamless as possible. As part of that commitment, we want to take a moment to clarify an important aspect of your care—one that affects how quickly and effectively we can support your health.
When a provider is out of network (OON), it means they do not have a contract with the patient’s insurance company. Because of that, the insurance relationship works differently in a few key ways:
1. The provider, if OON, is unable to submit any billing to the insurance directly
In many cases, out-of-network providers do not have electronic billing access or agreements with the insurer to submit claims on the patient’s behalf. Even when submission is technically possible, the insurer may still treat it as an “out-of-network claim” and process it differently or not accept provider-submitted claims at all.
2. Payment typically happens at the time of service
Since there’s no contract, we cannot accept payment directly from insurance companies. That’s why OON providers usually require patients to pay upfront, and then the patient seeks reimbursement.
3. The patient is responsible for submitting the claim
Instead of the clinic submitting the claim, the patient submits a “superbill” (an itemized receipt with diagnosis and procedure codes) directly to their insurance company. The insurance then reimburses the patient based on their out-of-network benefits.
4. Reimbursement goes to the patient, not the clinic
Even if insurance approves the claim, payment is typically sent to the patient—not the provider. This is also why clinics often cannot accept insurance checks for OON services.
While we cannot submit a claim we are happy to help with providing superbills, records, and further documentation if needed. Let us know how we can assist you through this process
Two Simple Steps Before Your Next Visit
To ensure your appointment goes smoothly, we ask that you:
- Complete your appointment questionnaire before every visit. This helps our team prepare and ensures nothing important is missed during your time with us.
- Bring your insurance card to every appointment, even if you believe your information hasn’t changed. Policies update more often than you might expect, and having your current details on hand keeps your care moving without interruption.
We’re Cash Pay & Out-of-Network—But Your Insurance Still Matters
While our office operates as a cash pay, out-of-network practice for office visits, your insurance information remains an essential part of your care. Here’s why:
Lab Orders
When we order lab work, your insurance is billed directly for those services. Without your current insurance details on file, we are unable to submit lab orders on your behalf.
Imaging Orders
The same applies to imaging referrals. Whether we’re ordering an ultrasound, or sleep test, GI test, or other testing your insurer needs to be on file to process those requests.
Prior Authorizations
Many treatments require prior authorization from your insurance provider before they can move forward. Without your up-to-date insurance information, we cannot initiate this process—which can result in significant delays to your care.
Delays We’d Both Like to Avoid
We know your time and your health are valuable. Without current insurance information on file, we are simply unable to send orders or process the necessary paperwork—which means longer wait times and potential gaps in your treatment plan. Keeping your details updated allows us to act quickly and efficiently on your behalf.
We understand that navigating insurance can feel complicated, and we are always here to help answer your questions. Our team is just a phone call or message away.
Thank you for trusting us with your health—and for taking these steps to help us serve you better.
