Our fees for out-of-network care
Pearl Health, Fertility, & Surgery is an out-of-network practice. That doesn't mean we don't work with insurance. It means your care is guided by your health needs, and we will help you use your out-of-network benefits.
Three simple steps
Verify your benefits
Check your out-of-network benefits before you come in. Reimbursify is free and lets you see what your plan covers for out-of-network care.
Verify with Reimbursify →Receive your care
We provide your superbill at the time of service, with the details your plan needs to consider your claim.
Submit and get reimbursed
Submit your superbill through Reimbursify, which is free for patients, or directly to your insurer. What you receive back depends on your plan's out-of-network deductible, coinsurance, and allowed amounts.
Before you call your insurer
Not sure what to ask? Our checklist covers your plan, your costs, surgery coverage, and reimbursement, so you know what to expect.
How billing works at Pearl
Your Pearl surgeon's fee is paid to Pearl. The hospital bills its own fees, so call your insurer to ask whether the hospital is in network. If it is, the hospital bills your insurance. If not, ask the hospital about its payment options.
More on paying for surgery →Pearl Health is out-of-network with all insurance plans beginning February 1, 2027, and is not able to see Medicare or Medicaid patients at this time. Outside labs, hospitals, and anesthesia bill separately. Your insurer, not Pearl, sets reimbursement amounts.
Verify your benefits and get reimbursed faster
We use Reimbursify so patients can check their out-of-network benefits and submit their superbills in one place. It is free for patients.
Opens Reimbursify in a new tab.
Why we're out-of-network
The conditions we treat are complex, and there is no one-size-fits-all treatment.
Being out-of-network means we are not limited to the services an insurance contract will allow. We can take the time to find the root cause and recommend the care that fits you.
There is a cost to this kind of care. Our aim is to find and treat the cause, so you can avoid years of trial and error, and we will be upfront about fees so you can plan.
In short
Your treatment is shaped by your health needs, not by what an insurance contract allows, and we will help you get reimbursed for what your plan covers.
Common questions
What does out-of-network mean?
It means we are not contracted with insurance companies to accept predetermined rates. It does not mean we don't work with insurance. You can submit our itemized receipt to your plan to seek reimbursement under your out-of-network benefits.
Will my insurance reimburse me?
That depends on your plan. Reimbursement depends on whether your plan includes out-of-network benefits, your out-of-network deductible and coinsurance, and the plan's allowed amounts. It is never guaranteed, which is why we recommend checking your benefits with Reimbursify before your visit.
How much will my care cost?
It depends on the services you need. Our team is happy to walk you through expected costs ahead of time, so you can plan with confidence.
How is surgery paid for?
Surgery usually involves more than one bill: the surgeon's fee, charges from the hospital or surgery center, and anesthesia. Facility and anesthesia charges are billed separately and may be covered under your in-network benefits. Our team will help you understand which charges go where before your surgery date.
What if my plan doesn't cover out-of-network care?
Your fees are the same for every patient, and you pay at the time of your visit. You still receive an itemized superbill, which some plans, including health shares, will accept for reimbursement. A few plans will also consider a network exception, sometimes called a gap exception, when the care you need isn't available in-network. Your insurer can tell you how to request one.
How does payment work?
We provide your superbill at the time of service, and you can submit it through Reimbursify to request reimbursement. Your care team can explain any payment details ahead of time.
This page is general information, not a guarantee of coverage or reimbursement. Please check your plan documents or contact your insurer for details.
Want to know more?
For questions about our fees or what to expect from your plan, send us a message and our team will walk you through it.