Don’t throw in the towel if the provider of your choice does not take your insurance.

Superbills are a wonderful gift that allow us to make empowered choices about who we see for medical care.  Superbills help you get paid by your insurance company!  What are they?

Quite simply, they are a complex receipt that your medical provider gives to you.  You then submit it on your own to your insurance company and then they pay you for a portion of your medical costs incurred.

Sounds like a bit of a hassle, why would anyone want to deal with superbills?  Here’s a few reasons why:

  1. If you want to see a particular specialist because everyone is recommending them.
  2. If your doctor or specialist stops taking your insurance.
  3. If your doctor stops submitting insurance claims as a courtesy for patients.
  4. If your insurance changes, but want to still see former providers.

Here is an example from my practice.  I stopped taking Blue Shield in May.  At that time, a couple Blue Shield patients wanted to keep seeing me, so we decided to use superbills.  The patient now pays me for the full cost of the visit, $100, then I hand them the superbill.  The patient then submits the superbill (according to Blue Shield’s superbill procedures) and the patient gets paid about $50 back per visit!  Most my patients wait until they have 4-5 superbills to submit and so they are getting a nice check for a couple hundred dollars every so often.

Here are some things you will want to find out to help budget for using superbills:

  1. Ask the provider you are wanting to see what the CPT codes are that they would be billing for you.  Usually I am billing 90791 and 90837.
  2. Ask the provider what the out of pocket costs are for those codes, mine are $125 and $100 respectively at the moment.*
  3. Call your insurance company and ask, “What is the reimbursement for Out of Network Providers for CPT code ______”.  This is the amount you will be reimbursed.
  4. While you have your insurance company on the phone, ask them what the procedure is for “submitting superbills…to collect reimbursement for seeing an Out of Network Provider”.  Most want one other form of theirs mailed in with the superbill.
  5. To figure out your costs, subtract what your insurance company reimburses for the CPT code from the amount your preferred provider charges for that CPT code.  So for example, I would bill $100 for 90837, your insurance company pays $66 for 90837, your costs per visit will be $34.

As you will see, it is definitely more complicated than the magic of having a provider do all of that for you.  But let me point out that having providers submit claims for their patients is a relatively new phenomenon.  In the 80’s most providers didn’t submit claims for their patrons.  It is a very costly and time consuming service as well.  I guarantee with costs going up for providers, you will see more an more providers getting off insurance panels or not submitting claims for their patients anymore.  You will be ahead of the game if/when that starts to occur.

Take charge of your medical care, just because someone doesn’t take your insurance doesn’t mean you can’t get medical treatment from them.  With a little extra effort and $, you can see whoever you want to see!

*Rates for treatment are subject to change.