Out-of-network benefits

Do you have health insurance? Many individuals with health insurance have both in-network and out-of-network benefits. This means that the in-network service providers (like therapists, doctors, nurses, etc.) have signed a contract to provide services to the insurance company’s clients at a specified rate and terms. There are other service providers (like me) who choose to work outside of this system and do not sign such contracts with insurance companies. However, these service providers may help clients with this type of insurance coverage by submitting reimbursement requests on the client’s behalf. I do.

Reimbursement methods

There are a couple methods for clients to obtain reimbursement for services provided by an out-of-network therapist:

Method 1: Superbill

At the client’s request, a therapist may provide a “superbill” which is a simple document that the client can use to submit for reimbursement from their insurance company. I can generate one easily in my electronic records management system. I understand that every insurance company has their own process for reimbursement, and I have been told that some of the requirements are administratively burdensome and antiquated. Using this method, the therapist provides the superbill report and the client takes it from there. Please note that not all insurers offer out-of-network benefits/coverage.

Method 2: Courtesy billing

Upon request by the client, I may be able to electronically submit a reimbursement request to the client’s insurer through a secure billing system. This saves the client from having to remember and coordinate reimbursement submissions. I do this.

Fair disclosure: I am aware of two potential negatives with this method:

1) Once the therapist submits the request to the insurance company, they have no insight into the status of the request. Therefore, if there is a breakdown in the process at the insurance company, the client must figure it out themselves.

2) I cannot guarantee that your insurance company will permit me to submit claims on your behalf.