Clear Information Before Care Begins
Insurance & Payment
Cardiel Precision Brain Health is a private, direct-pay, out-of-network neurology practice.
The practice does not participate with commercial insurance plans, and Dr. Myrna Cardiel has formally opted out of Medicare. Payment is due at the time of service. Applicable fees will be explained before your appointment so you can make an informed decision about care.
Commercial Plans
Commercial Insurance & Out-of-Network Benefits
Cardiel Precision Brain Health is out-of-network with all commercial insurance plans. Reimbursement, when available, is determined entirely by the patient’s plan.
If Your Plan Includes Out-of-Network Benefits
Your insurer may reimburse a portion of the visit fee after any applicable out-of-network deductible. The amount depends on your deductible, coinsurance, the plan’s allowed amount, and its claim-processing rules.
Reimbursement is not necessarily based on the physician’s actual fee. It may instead be calculated from a lower allowed amount established by the plan.
Superbills & Claim Documentation
Upon request, the practice can provide a detailed superbill containing the diagnostic and procedure codes needed to submit a commercial out-of-network claim.
The practice cannot guarantee reimbursement or determine how your insurer will apply the claim to your deductible, coinsurance, or out-of-pocket maximum.
What Should I Ask My Insurance Company?
Call the member-services number on your insurance card and consider asking each of the following:
- Does my plan include out-of-network benefits for outpatient neurology services?
- What is my individual out-of-network deductible?
- How much of that deductible have I met this plan year?
- After the deductible is met, what percentage does the plan reimburse?
- Is reimbursement based on the physician’s actual fee or the plan’s allowed amount?
- What is the allowed amount for the anticipated CPT code, if available?
- Is a referral or prior authorization required?
- Is there a separate out-of-network out-of-pocket maximum?
- How do I submit a superbill, and what is the filing deadline?
The practice can explain its fees and provide anticipated billing codes when available. Only your insurance company can confirm how your particular plan will process a claim.
Diagnostic Testing & Outside Services
When medically appropriate, the practice will make reasonable efforts to direct laboratory testing, imaging, and other diagnostic services to facilities that participate with your plan. These services are billed separately by the outside entity. Coverage, prior authorization, deductibles, and copayments remain subject to your plan. Please confirm that the facility is in-network before receiving services.
Original Medicare & Medicare Advantage
Dr. Myrna Cardiel Has Formally Opted Out of Medicare
Medicare patients may choose to receive care from Dr. Cardiel under a private agreement, but her professional services are paid directly by the patient and are not submitted to Original Medicare or Medicare Advantage for reimbursement.
Dr. Cardiel’s Professional Services
Patients with Original Medicare or a Medicare Advantage plan who choose to see Dr. Cardiel must enter into a private contract with the practice and pay her professional fees directly.
Neither the practice nor the patient submits claims for those contracted professional services. Special Medicare rules apply when emergency or urgent care is required.
Choosing private care with Dr. Cardiel does not affect your ability to receive covered care from other Medicare-participating physicians, hospitals, laboratories, or facilities.
Testing, Equipment & Prescriptions
Separately billed items and services ordered or certified by an opted-out physician may remain eligible for Medicare coverage when Medicare’s requirements are satisfied, including:
- Clinical laboratory testing
- MRI, CT, PET, and other imaging
- Eligible durable medical equipment
- Eligible home-health services
Coverage depends on medical necessity, valid ordering or certification requirements, and the participation status of the laboratory, imaging center, supplier, or agency. Medicare Advantage patients should also confirm network and prior-authorization rules. Prescription coverage is governed separately by the patient’s Part D or Medicare Advantage drug plan and its formulary.
General Medicare information is based on current Centers for Medicare & Medicaid Services opt-out guidance. Individual coverage decisions remain subject to Medicare and plan requirements.
Common Questions
Frequently Asked Questions
Select a question to review the answer.
Do you bill commercial insurance directly?
No. Payment is made directly to the practice. Patients with commercial out-of-network benefits may request a superbill to submit to their insurance company.
Does receiving a superbill guarantee reimbursement?
No. Reimbursement depends on your plan’s out-of-network benefits, deductible, coinsurance, allowed amount, filing requirements, and claims policies.
Can Medicare patients receive a superbill for Dr. Cardiel’s services?
No. Because Dr. Cardiel has opted out of Medicare, claims for her contracted professional services may not be submitted to Original Medicare or Medicare Advantage for reimbursement.
Will insurance or Medicare still cover testing ordered by Dr. Cardiel?
It may. Laboratory testing, imaging, medications, equipment, and other services are billed separately by the entity providing them. Coverage depends on medical necessity, valid ordering requirements, network participation, prior authorization, and the terms of the patient’s plan.
Will I know the cost before my appointment?
Yes. The practice will explain the applicable fee before your appointment. Patients who do not have or do not use insurance are entitled to a Good Faith Estimate when required by federal law, and an estimate is also available upon request.
Who can tell me how much my insurance will reimburse?
Only your insurance company can provide plan-specific benefit information or make a coverage determination. The practice can explain its fees, documentation, and anticipated billing codes when available, but cannot predict or guarantee reimbursement.
This page provides general financial and coverage information. It is not a guarantee of benefits, payment, reimbursement, or authorization by any insurer, Medicare, Medicare Advantage plan, or outside facility.
Questions Before Scheduling?
We Are Happy to Explain Our Fees and Documentation
The practice can explain the applicable fee and the documentation it can provide. For a plan-specific reimbursement estimate or coverage decision, please contact your insurance company directly.