Overview

Insurances We Are ( In Network)

My Beverly Hills pediatric practice is in-network with

• Blue Shield insurance plans.
• Blue Cross PPO 

If you have any of the above coverages, I will bill your insurance directly and you’ll only be responsible for your regular co-pay, deductible, or coinsurance as outlined in your specific plan. My office will handle all the paperwork and coordination with Blue Shield to make your visit as seamless as possible.

Out of Network insurances

For patients with 

• Aetna insurance 

or other insurance plans, I operate as an out-of-network provider. While this may seem different from what you’re used to, many families find that out-of-network care offers significant benefits including longer appointment times, same-day availability, direct access to me, and personalized attention that busy in-network practices often cannot provide.

How Payment Works for Out-of-Network Insurance

If you have Aetna or another insurance plan where I am out-of-network, payment is due at the time of your visit. I accept cash, credit cards, debit cards, and health savings account (HSA) or flexible spending account (FSA) cards. After your appointment, I will provide you with a detailed superbill that includes all the information your insurance company needs to process your claim. A superbill is an itemized receipt that contains the diagnosis codes, procedure codes, and other medical information required for insurance reimbursement.

You can submit this superbill directly to your insurance company for reimbursement according to your plan’s out-of-network benefits. Many insurance plans, including Aetna PPO plans, cover a significant portion of out-of-network pediatric care, and families are often surprised to find they receive substantial reimbursement. The amount you receive back depends on your specific insurance plan’s out-of-network coverage, deductible, and co-insurance rates.

Understanding Your Out-of-Network Benefits

Before your first visit, I encourage patients with Aetna or other out-of-network insurance to contact their insurance company and ask about their out-of-network pediatric benefits. Here are important questions to ask your insurance provider:

• What is my out-of-network deductible and has it been met?
• What percentage does my plan cover for out-of-network pediatric services?
• Is there a limit on out-of-network benefits?
• Do I need a referral for out-of-network care?
• How do I submit claims for reimbursement?

Most PPO plans, including many Aetna plans, offer out-of-network coverage that reimburses anywhere from 60% to 80% of covered services. Some plans have excellent out-of-network benefits that make the cost difference minimal. Understanding your specific benefits helps you make an informed decision about your child’s healthcare.

Why Families Choose My Practice

Many Beverly Hills families specifically choose my practice because of the superior level of care and attention they receive, regardless of their insurance network status. Whether you’re in-network with Blue Shield or choose to see me out-of-network with Aetna or another plan, you’ll experience the same high-quality, personalized pediatric care. The benefits include more time during appointments, easier access to me as your pediatrician, continuity of care with the same doctor every visit, and a healthcare experience focused on your child’s needs.

The investment in quality pediatric care often pays for itself through better health outcomes, fewer urgent care visits, and the peace of mind that comes from having a dedicated pediatrician who knows your child and is always available when you need guidance. For many families with out-of-network coverage, the personalized attention and quality of care make the cost difference well worth it, especially after insurance reimbursement.

Questions About Insurance and Payment

If you have questions about in network and out of network insurances, superbills, or how to maximize your insurance reimbursement, please don’t hesitate to call my office. My staff is experienced in helping families navigate both in-network and out-of-network benefits and can provide guidance on the reimbursement process. I want every family to feel comfortable and informed about the financial aspects of care so you can focus on what matters most, your child’s health and wellbeing.

We strongly encourage you to contact your insurance company (e.g., Aetna) before your first visit to confirm your specific OON coverage. Ask them these key questions:

• What is my out-of-network deductible, and how much of it have I met this year?

• What percentage does my plan cover for out-of-network pediatric services (e.g., 60%, 80%)?

• Is there an annual limit on out-of-network benefits?

• Do I need a referral to see an out-of-network provider?

• What is the exact process for submitting a claim for reimbursement?

For many PPO plans, OON reimbursement can cover a significant portion of the cost, often making the investment in personalized care highly worthwhile.