The Benefits of Out-of-Network Care and How to Use a Superbill for Reimbursement
You have made the choice to work with an Out-of-Network Provider. Now what?
Access to Expert Knowledge and a Provider you Connect With
By working with an OON provider, you are gaining access to a specialist who often has unique qualifications and advanced training. This allows for better treatment outcomes and a more fine-tuned approach. When you choose an OON provider, you are no longer limited to a pre-approved list from your insurance company. You pick someone based on their professional attributes and work style.
Individualized, Patient-Focused Care
Unlike in-network providers who follow insurance-mandated restrictions, OON providers are able to spend more time and attention dedicated to each appointment with their patient and allow for time spent preparing for that appointment.
Less Time Spent Waiting for an Appointment
In-network providers are in high demand because of insurance companies making the referrals. The result is patients waiting a long time for appointments. OON providers can offer more timely support when patients need to be seen.
Maintaining your Privacy
An in-network provider must disclose sensitive details about you (diagnosis, treatment, etc) when an insurance claim is made. You can maintain privacy and control over your personal health information when you work with an OON provider, as no claim is being made.
What is a Superbill and how do I use it?
A Superbill is a receipt provided by OON providers that includes information your insurance company requires to work through a claim for reimbursement (diagnosis, treatment codes, service provided, fee paid, etc.) Patients using OON services submit Superbills directly to their insurance company for reimbursement. Submitting a Superbill is much easier than it may seem. Submitting a Superbill can help offset the costs of private pay care significantly.
Ask Your Insurance Provider These Questions Before Submitting a Superbill:
- Do I have Out-of-Network benefits?
- What is my OON deductible and how much of the deductible have I met so far?
- Does the insurance cover the service I am getting?
- What is my coinsurance rate (percentage of the fee reimbursed after meeting my deductible)?
- Where and how do I submit my Superbill (online portal, fax, or mail)?
- Do I need a referral or pre-authorization before my appointment?