I am an "out of network" provider. When working with an "out of network" provider, you will pay your therapist directly, and then submit a claim for reimbursement from your insurance company. How do you submit a claim? Here is a quick guide:
Filing Your Claim Online: It is very likely you can file your claims for reimbursement online, on your insurance company's website.
Step 1: Sign in to your account on your health insurance company's website
Step 2: Find "Submit a claim online"
Step 3: Fill in the information the online form in requesting
Step 4: Scan and upload a copy of the superbill supplied to you by your therapist
The information your insurance company will request will already be on the superbill given to you by your therapist, but to clarify, this is what information will be needed:
Provider's name and address
Provider's tax ID number (EIN, NPI, or SSN)
Diagnosis code ("ICD")
Procedure Code ("CPT")
Filing Your Claim by Mail: If you are unable to file your claim for reimbursement online, you will fill out and send in a paper claim form. You will attach a copy of the superbill to the form, and mail it to your insurance company. You can find the claim form on your insurance company's website, where you will be able to print it out. Please note, some insurance companies use a different form and it might be under "behavioral health".
Because you have already paid your therapist who is "out of network", and you are filing for reimbursement, you will want to write in bold letters and highlight on the claim form, "PATIENT HAS ALREADY PAID PROVIDER - PLEASE REIMBURSE PATIENT".
Diagnosis: you will enter this as a code, which will be on the superbill
Place of service: for psychotherapy in your therapist's office, the code will typically be "Office" which is code "11".
Description of Services, or CPT: CPT is the code for what kind of service your therapist provided, and should be on your therapist's superbill.
NPI #: Your therapist will have an NPI # on the superbill; if they do not, just write "none".
Assignment: Do not sign anything that says "authorize assignment", since you have already paid your therapist and are filing for reimbursement. If you authorize or assign your benefit, that means the insurance company will send a check to your therapist instead of you.
Filing Your Claim Online: It is very likely you can file your claims for reimbursement online, on your insurance company's website.
Step 1: Sign in to your account on your health insurance company's website
Step 2: Find "Submit a claim online"
Step 3: Fill in the information the online form in requesting
Step 4: Scan and upload a copy of the superbill supplied to you by your therapist
The information your insurance company will request will already be on the superbill given to you by your therapist, but to clarify, this is what information will be needed:
Provider's name and address
Provider's tax ID number (EIN, NPI, or SSN)
Diagnosis code ("ICD")
Procedure Code ("CPT")
Filing Your Claim by Mail: If you are unable to file your claim for reimbursement online, you will fill out and send in a paper claim form. You will attach a copy of the superbill to the form, and mail it to your insurance company. You can find the claim form on your insurance company's website, where you will be able to print it out. Please note, some insurance companies use a different form and it might be under "behavioral health".
Because you have already paid your therapist who is "out of network", and you are filing for reimbursement, you will want to write in bold letters and highlight on the claim form, "PATIENT HAS ALREADY PAID PROVIDER - PLEASE REIMBURSE PATIENT".
Diagnosis: you will enter this as a code, which will be on the superbill
Place of service: for psychotherapy in your therapist's office, the code will typically be "Office" which is code "11".
Description of Services, or CPT: CPT is the code for what kind of service your therapist provided, and should be on your therapist's superbill.
NPI #: Your therapist will have an NPI # on the superbill; if they do not, just write "none".
Assignment: Do not sign anything that says "authorize assignment", since you have already paid your therapist and are filing for reimbursement. If you authorize or assign your benefit, that means the insurance company will send a check to your therapist instead of you.