If a provider doesn’t accept your insurance, your insurance may not cover medical bills. There is a way to circumnavigate this – submitting a superbill! A superbill is a document you can send to your insurance company in order to reimburse you for out-of-network costs.
- Superbills can be used to minimize out-of-pocket healthcare expenditures.
- The superbill submission process typically varies among insurance plans. Reach out to your insurance provider to understand directions beforehand.
Anatomy of A Superbill
This may vary from plan to plan. Generally, the superbill will need some or all of the following information from your provider:
- NPI number or Tax ID
- Note: Be sure to ask if they need this information on behalf of the provider (Type 1 NPI, individual tax ID) or organization (Type 2 NPI, group tax ID).
- Legal name of the organization
- Corporate mailing address of the organization
- CPT code(s)
- This denotes the specific service rendered. For example, a physical therapist can use code 97164 to let your insurance company know that you underwent a re-evaluation, which they would like to be reimbursed for.
- ICD codes
- Dates of Service
- Itemized list of charges
- This is slightly different from the CPT code. While a CPT code shows what services were rendered, the itemized list is a list of charges. Sticking with the physical therapy example, this may include any additional costs incurred during the appointment, such as cold packs.
You can request that your provider shares this information with you on a document with a letterhead, or they can use a template from a system like Kareo or Healthie. Be sure to include any supplemental documents if required. For example, some plans may also need a claims submission form, which you can find and fill out online before sending.
What To Ask Your Insurance Company:
- Is [insert service here] eligible for reimbursement via superbill?
- Is prior authorization for [insert service here] required?
- What information must be included within the document?
- How long after a date of service may I submit a superbill and still be eligible for reimbursement?
- Should I submit the documents online, or by mail? Can you share the directions for submission, or can they be found elsewhere?
Always submit your own superbills, even if your provider offers to do so on your behalf. This way, you can track correspondence and ensure that you’re reimbursed in a timely manner. Be sure to document the date on which you submit the documents, follow up to confirm receipt of the documents and ensure that your insurance provider has all the information needed to process the claim. Be patient and persistent. Good luck!
Outside the Huddle
- Encounter Form Samples | Kareo
- What is a Superbill? | Healthie
- How do I receive out of network reimbursement for Cerebral payments? | Cerebral
- Understanding how to submit a claim | United Healthcare
- Superbills: ICD-9 vs. ICD-10 | American Academy of Professional Coders
- Introduction to Billing Code Systems | American Speech-Language-Hearing Association