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  • Writer's pictureTiffany Lowther

Understanding Superbills and Managing Health Insurance with Out-of-Network Providers



You've done your research and found a great provider who you want to work with, but they don't take your health insurance. What do you do? Navigating mental health care can be complex, especially when working with providers who are out-of-network. As a provider, I understand that insurance reimbursement can feel overwhelming. Having a background in working with health insurance, I am happy to discuss your options and how you can go through the steps of requesting and submitting for reimbursement from health insurance companies such as Cigna, BCBS, Tricare and UnitedHealthcare. One very important tool to understand is the superbill. This blog will explain what superbills are and offer steps to manage your health insurance effectively while receiving care from out-of-network providers.


What is a Superbill?

A superbill is a detailed invoice provided by your healthcare provider after you receive services. Unlike a standard receipt, a superbill includes comprehensive information required by insurance companies to process reimbursement claims. Key elements typically found in a superbill include:

  • Provider’s information

  • Patient’s information

  • Date of service

  • Description of services provided (including CPT codes)

  • Fees for each service

  • Diagnosis codes (ICD-10)

For a more detailed explanation, you can read about superbills here.


Why Use a Superbill?

If your mental health provider is out-of-network, they do not bill your insurance directly. Instead, you pay for services upfront and then use the superbill to seek reimbursement from your insurance company. This process allows you to receive care from the provider of your choice while still potentially getting some financial relief from your insurance plan.


Steps to Manage Health Insurance with an Out-of-Network Provider

  1. Verify Your Benefits: Before your first appointment, look on the back of your insurance card and contact your insurance company to understand your out-of-network benefits. Ask about reimbursement rates, deductible amounts, and any required forms.

  2. Collect Your Superbill: After each session, request a superbill from your provider. Ensure it includes all necessary information for insurance reimbursement. Here’s a guide on what a superbill should include. My system can create a monthly superbill that will go straight to you with all the information you will need to submit it to your health insurance company.

  3. Submit Your Superbill: Send the superbill to your insurance company. This can often be done through their online portal or via mail. Include any additional required documentation. Here’s a step-by-step guide on submitting out-of-network claims.

  4. Track Your Claims: Keep a record of all submitted superbills and follow up with your insurance company if you don’t receive a response within their specified timeframe. You can use a spreadsheet or dedicated app to track your claims and reimbursements.

  5. Understand Your Reimbursement: Once processed, your insurance company will send you an Explanation of Benefits (EOB). This document details how much was covered, what you owe, and any remaining deductible. Understanding your EOB is crucial; you can find a detailed explanation here.

  6. Seek Assistance if Needed: If the process feels overwhelming, consider hiring a medical billing advocate. These professionals can help you navigate the reimbursement process, ensuring you receive the maximum possible reimbursement. Learn more about medical billing advocates here.

  7. Utilize Mentaya for Support: Mentaya offers a service designed to simplify the process of getting reimbursed by your insurance company. By using Mentaya, you can easily generate and submit claims, track your reimbursements, and receive guidance throughout the process. This can significantly reduce the administrative burden on you and help ensure that you get the reimbursement you deserve.


Final Thoughts

While working with an out-of-network provider can initially seem daunting due to the upfront costs and additional paperwork, understanding how to use superbills effectively can significantly ease the financial burden. By taking these steps, you can ensure you receive the care you need while maximizing your insurance benefits.


For further reading on managing healthcare costs and insurance, visit HealthCare.gov and Verywell Health.


Lowther Counseling Services, www.LowtherCS.com, 2024

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