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Out-Of-Network Insurance

Out-of-network insurance refers to a type of health insurance coverage in which an individual receives medical services from providers who do not have a contract with the individual's insurance company.

How Does out of network Insurance work?

When an individual receives care from an out-of-network provider, they will typically be required to pay the cost of the services at the time they are received, and the insurance company will then reimburse them for a portion of the cost. The amount of the reimbursement will depend on the patient specific insurance plan. The individual will have to pay the entire expense of the services upfront and then use a superbill to file a reimbursement claim with the insurance company. It's important for the patient to check with their insurance company for the specific terms and coverage of out-of-network coverage.

What is a Superbill?

A superbill, also known as a charge slip or billing slip, is a document used by healthcare providers to itemize services and charges for a patient's visit. It includes the patient's personal information, the date of the visit, the services rendered, and the charges for each service. The superbill is then used by the patient or the patient's insurance company to submit a claim for reimbursement.

In the case of insurance, the superbill contains codes that are used by insurance companies to process the claim and determine how much of the cost will be covered by the patient's insurance. Providers may give the superbill to the patient to submit to the insurance company utilizing the medical records system, Osmind.

It is important to note that insurance superbill is used for out-of-network provider visit, as they are not contracted with the insurance company.

Steps to claim out-of-network insurance. 

Submitting a superbill to your insurance company typically involves the following steps:

  1. After you receive treatment please email the practice manager requesting a superbill for the service received. 

  2. Review the superbill: Verify that all of the information on the superbill is correct, including your personal information, the date of the visit, and the services and charges.

  3. To submit the superbill to your insurance company, it can be done through mail, online or by using our medical records system called Osmid.

  4. Keep a copy of the superbill and any other documentation: It's a good idea to keep a copy of the superbill, and any other documentation you submit to the insurance company for your records.

  5. Check the status of your claim: You can check the status of your claim by calling the customer service number on the back of your insurance card or by visiting the insurance company's website.

  6. Follow up on denied claims: If your claim is denied, you can appeal the decision by following the instructions provided by the insurance company.

It's important to note that not all insurance companies accept superbill, and different insurance company may have different process for submitting superbill. It's always best to check with your insurance company for specific instructions and requirements on how to submit a superbill.

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