However, if your plan has out-of-network benefits, your insurance company typically will reimburse you directly after you’ve met your deductible.
Typically, when a client receives care from an out-of-network provider, they will need to pay the full cost of the services upfront. Afterward, they can submit a claim to their insurance company for reimbursement. The insurance company will review the claim, determine the eligible amount to be paid based on their out-of-network coverage policy, and then issue reimbursement directly to the client.
All of our therapists are Out-of-Network providers. This means that we’re not in-network or credentialed with any insurance companies.
Billing at Madison Square: All You Need to Know
Understanding your out-of-network benefits
It is a document that your mental health provider gives to patients after a session, outlining the services rendered and the associated costs.
The primary purpose of a superbill is to facilitate the reimbursement process between patients and their insurance companies. It contains all the necessary information that insurers require to process claims and reimburse patients for covered medical expenses.
A superbill is a detailed itemized statement or form used in medical billing.
What is a superbill?
- Patient Information: Patient name, date of birth, contact details, insurance information, and any relevant patient identification.
- Provider Information: Therapists name, NPI, Tax ID, practice address, contact details, and any other necessary provider information.
- Date(s) of Service: The date(s) on which the medical service was provided.
- CPT (Current Procedural Terminology) Codes: These are standardized codes that represent medical procedures and services. Each service provided during the appointment is assigned a specific CPT code.
- Diagnosis Code (ICD-10): Diagnosis codes that correspond to the patient’s medical condition. These codes explain why the services were performed.
- Description of Services: A brief description of the medical services or procedures performed during the appointment.
- Place of service (POS): The code that is related to in-person or virtual visit. 11 is the POS code for in-person (an appointment takes place with the client in the therapist’s office). 10 is the POS for telehealth visits.
- Units: The quantity of each service provided. For instance, if a patient received two vaccinations, there would be two units listed for that specific service.
- Fee or Charge: The cost associated with each service rendered, along with the total charges for the appointment.
What information is included on a superbill?
This email will provide a secure link for you to download your superbill. Submitting a superbill involves sending the document to your insurance company for reimbursement or keeping it for your records.
Remember that the specific process can vary based on your insurance company’s policies and the nature of the medical services. Always communicate directly with your insurance company to ensure you follow the correct procedure for submitting a superbill.
If you are receiving superbills you will receive an email from Simple Practice on the 5th of every month for the month prior.
How to submit a superbill to insurance:
Depending on your insurance company’s requirements, you may need to upload electronically, mail, fax, or submit the superbill through an online portal. Some insurers might also require you to fill out a claim form along with the superbill.
3) Submit superbill
Search your insurance website or contact them to inquire about their specific submission process, required forms, and any additional documentation they may need.
2) Contact insurance
Double-check the accuracy of the information on the superbill, including service dates, service descriptions, codes, and costs.
1) Review
If your insurance or credit card information changes or expires, please make sure to update your information by emailing [email protected].
Once you hit your out-of-network deductible, your insurance company should send you a check in the mail reimbursing you for a portion of your sessions (amounts vary by plan). Usually this may take a few weeks for processing after you submit your superbill.
6. Get reimbursed
If you don’t receive reimbursement or any response from your insurance company within a reasonable time frame, follow up with them to inquire about the status of your claim.
5) Follow up
Make sure to keep a copy of the submitted superbill, claim form (if applicable), and any other related documents for your records.
4) Keep a copy
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