Being out-of-network simply means that ACI does not have a negotiated contract with every insurance company. This is not a reflection of the quality of care — it is purely a matter of insurance arrangements. Depending on your specific plan, your insurer may still cover a portion of your care at ACI, though your out-of-pocket costs may be higher than they would be with an in-network provider. We encourage all patients to contact their insurance company before their visit to understand their out-of-network benefits and any potential costs. Our team is also available to help answer questions and assist you in navigating the process.

Coverage for out-of-network care varies significantly depending on your insurance plan type. PPO plans typically offer some level of out-of-network benefits, meaning your insurer may reimburse a portion of your costs after you meet your out-of-network deductible. HMO plans, on the other hand, generally do not cover out-of-network care except in emergencies. If you have a Medicare Advantage HMO plan, out-of-network coverage may be limited or unavailable. The best way to know what your plan covers is to call the member services number on the back of your insurance card and ask about your out-of-network benefits before your appointment.

A superbill is an itemized receipt provided by a healthcare provider that includes all the information your insurance company needs to process a reimbursement claim — including procedure codes, diagnosis codes, dates of service, and provider information. If your insurance plan offers out-of-network benefits, ACI can provide you with a superbill that you can submit directly to your insurer for potential reimbursement. We recommend keeping copies of all bills, receipts, and correspondence with your insurer throughout this process.

Yes, ACI accepts Medicare. Traditional Medicare (Parts A and B) typically provides out-of-network coverage, meaning Medicare beneficiaries can generally see any provider who accepts Medicare assignment regardless of network status. If you have a Medicare Advantage plan, coverage for out-of-network care will depend on the specific plan type — PPO-style Medicare Advantage plans often offer out-of-network benefits, while HMO-style plans typically do not. Please contact our office or your plan directly to confirm your coverage before your visit.

ACI welcomes self-pay patients and is committed to working with individuals who do not have insurance coverage. If you are uninsured, please contact our office to discuss your options. Our team can walk you through expected costs and work with you to find a solution that makes your care as accessible as possible. Your heart health is too important to delay — we encourage you not to let insurance concerns stand in the way of getting the care you need.

In some cases, yes. If your insurance plan requires prior authorization for out-of-network specialist visits, your primary care physician can submit a referral request to your insurer on your behalf. A prior authorization request is typically supported by documentation of your diagnosis and the medical necessity of seeing a specialist with Dr. Nia's level of expertise and experience. While authorization is not always guaranteed, it is worth pursuing if it could help reduce your out-of-pocket costs. Contact your insurance company for specific instructions on how to initiate this process.

If you have questions about a bill from ACI, please contact our office directly. Our team is happy to review charges with you, provide documentation for insurance reimbursement purposes, and discuss payment options if needed. We believe in transparency and open communication, and we will do everything we can to ensure that billing is never a barrier to your continued care.