Home/New Patients/Out-of-Network Care
Out-of-Network Care
Not in network is not the same as not an option.
If your plan is one we do not participate with, you may still be able to be seen here. Many PPO plans include out-of-network benefits, and many of our patients use them to stay with Dr. Kim. What those benefits are worth varies from plan to plan — so before you decide anything, we will find out what yours actually covers, at no charge.
The vocabulary
What the words on your plan actually mean.
Out-of-network coverage is described in terms most people never have a reason to learn. These are the ones that determine what you pay.
Out-of-network benefits
The part of your plan that pays toward care from a provider your insurer has no contract with. Most PPO plans include them. HMO and EPO plans usually do not, except in emergencies.
Out-of-network deductible
The amount you pay yourself before the plan begins contributing. It is separate from your in-network deductible and usually higher, and it resets each plan year.
Coinsurance
Once the deductible is met, the share your plan pays — often expressed as something like 70/30. The percentage applies to the allowed amount, not to the bill.
Allowed amount
What your plan decides a service is worth. Coinsurance is calculated from this figure, so the allowed amount matters as much as the percentage does.
Out-of-pocket maximum
The ceiling on what you pay in a plan year. Many plans set a separate, higher ceiling for out-of-network care, and some set none at all.
Superbill
An itemized receipt with the diagnosis codes, procedure codes, charges and provider identifiers your insurer needs. You submit it to your plan to claim reimbursement.
How it works here
Four steps, and we do the first one for you.
We verify your benefits
Our team contacts your carrier to confirm your out-of-network deductible, how much of it you have met, your coinsurance rate, and whether prior authorization is required for anything planned.
You pay Yunella at the time of service
Out-of-network care is paid directly to us on the day. We give you a written estimate of our charges beforehand, so nothing about the amount is a surprise.
You receive a superbill
After each visit, an itemized statement with every code and identifier your insurer requires. Nothing else needs to be assembled.
You submit it, and your plan reimburses you
You send the superbill to your insurer and any reimbursement goes to you rather than to us. Your plan will send an explanation of benefits showing how the claim was applied.
Benefits verification is based on information provided by your insurer and is not a guarantee of coverage or payment. The allowed amount, and therefore your final reimbursement, is determined by your plan when the claim is processed.
Before you decide
What to ask your insurer.
We will ask these for you if you would rather not spend the afternoon on hold. If you prefer to call yourself, these are the questions that actually change the answer.
- Do I have out-of-network benefits for outpatient office visits? And, if it applies to you, for obstetric care and for surgery.
- What is my out-of-network deductible, and how much of it have I met this year?
- What is my coinsurance rate once the deductible is met?
- How does the plan determine the allowed amount for out-of-network services? This is the question most people skip, and it is the one that decides the number.
- Is there an out-of-network out-of-pocket maximum, or is it unlimited?
- Does anything I am planning require prior authorization?
- How do I submit an out-of-network claim, and what is the deadline for submitting it? Plans set their own filing deadlines. Missing one forfeits the reimbursement.
You do not have to work this out alone.
Tell us your carrier and what you are coming in for. We will call them, and come back to you with what your plan covers and what to expect — at no charge.
If you are an Aetna or Cigna patient
You do not have to change physicians.
Effective September 26, 2026, Yunella Women’s Health will no longer participate in network with Aetna or Cigna. For most of our Aetna and Cigna patients, the practical question is not whether to leave — it is what staying will cost.
Call us before your next visit. We will verify your out-of-network benefits with Aetna or Cigna and tell you what your plan covers, so you are deciding with a real number rather than a guess.
If you are pregnant, tell us your due date when you call. Obstetric care is often billed as a single global charge rather than visit by visit, and plans treat that differently out of network. It is worth working through before your next appointment.
If you have a procedure scheduled, let us know the date. Prior authorization requirements can differ once a plan is out of network.
Being straight with you
What we can and cannot tell you.
We can tell you what your carrier reports. Your deductible, how much of it you have met, your coinsurance rate, whether prior authorization is needed, and what our charges will be.
We cannot tell you what your plan will ultimately pay. That depends on the allowed amount your insurer assigns to each service, which is decided when the claim is processed rather than beforehand. Any practice that promises you an exact reimbursement figure in advance is guessing.
We would rather give you a real range now than a confident number that turns out to be wrong.
Complimentary
We will check your benefits for you.
Send us your information and we will contact your carrier directly. You will hear back with your deductible, your expected out-of-pocket cost, and what your plan covers out of network — usually within one to two business days.
Questions
What patients ask about out-of-network care.
Can I be seen at Yunella if you are not in network with my insurance?
In most cases, yes. If your plan includes out-of-network benefits, you can be seen here and use them. We will verify what your plan covers before you schedule, at no charge.
What are out-of-network benefits?
They are the portion of a health plan that pays toward care from providers the plan has no contract with. Most PPO plans include them; HMO and EPO plans usually do not, except in emergencies.
Do I pay Yunella directly?
Yes. For out-of-network care, payment is due to Yunella at the time of service. We then give you an itemized superbill, which you submit to your insurer for any reimbursement available under your plan.
What is a superbill?
An itemized receipt containing everything your insurer needs to process an out-of-network claim: the date of service, the diagnosis codes, the procedure codes, the charges, and the practice and physician identifiers. You submit it to your plan yourself.
How much will my insurance reimburse?
That depends on your out-of-network deductible, your coinsurance rate, and the allowed amount your plan sets for each service. We will tell you what your carrier reports before you schedule, but the final amount is determined by your plan when the claim is processed.
How long does reimbursement take?
It varies by carrier. Your plan will send an explanation of benefits showing how the claim was applied. Most plans also set a deadline for submitting out-of-network claims, so check yours and send the superbill promptly.
I have Aetna or Cigna. What happens to my care?
Effective September 26, 2026, Yunella no longer participates in network with Aetna or Cigna. If your plan includes out-of-network benefits, you can continue your care here without changing physicians. Call us and we will check your benefits and explain what to expect.
I am pregnant. Does out-of-network work differently for maternity care?
It can. Obstetric care is often billed as a single global charge covering prenatal visits and delivery rather than visit by visit, and plans treat that differently out of network. Hospital and anesthesia charges are billed separately by those providers. We will walk through the whole picture with you before you decide.
What if my plan has no out-of-network benefits?
Then you would be seen on a self-pay basis. We will prepare a written estimate of expected charges before you schedule so you can decide with the number in front of you.
Can I use out-of-network benefits at an OB-GYN in Los Angeles?
In most cases, yes, if your plan is a PPO with out-of-network coverage. Yunella Women's Health verifies those benefits with your carrier at no charge before you schedule, and provides an itemized superbill after each visit for reimbursement.
What is a superbill, and what do I do with it?
A superbill is an itemized receipt containing the date of service, diagnosis and procedure codes, charges, and provider identifiers your insurer needs. You submit it to your plan yourself, and any reimbursement is paid to you rather than to the practice.
Does out-of-network care cost more?
Usually you pay more out of pocket than you would in network, because out-of-network deductibles are higher and reimbursement is based on the allowed amount your plan sets. How much more depends entirely on your plan, which is why we verify it before you decide.
For which plans we do participate with, self-pay care, and payment policies, see Insurance & Payment.
Start here
Find out what your plan covers before you decide anything.
It takes us a phone call, and it costs you nothing.
Or call (424) 404-8832 · 6330 San Vicente Blvd, Suite 418, Los Angeles, CA 90048