Let’s be frank – insurance claims are confusing, sometimes inconvenient, and can take a serious amount of time to figure out. When all you’re trying to do is get the right kind of services or healthcare treatment for you and your family, the last thing you want to think about is the cost, especially if you’re working with out-of-network providers.
On top of that, medical insurance networks can place unnecessary limitations on your healthcare. If you stick to in-network providers, they might not be the best match for your medical needs, or you could end up waiting weeks for an imperative appointment. And if you decide on an out-of-network provider, the wider selection can come at a cost – both your money and your time.
That’s where SuperBill can help you out. Their services give you the freedom to select out-of-network providers and maximize reimbursement returns without stress.
By simply submitting your bills through their convenient portal, they’ll handle the frustrating and time-consuming process of filling out reimbursement forms and negotiating out-of-network claims for one reasonable monthly or annual fee.
TLDR: Cutting to the chase
If your preferred or necessary providers are out of your medical network, our SuperBill review will answer your questions – how does out-of-network reimbursement work? How are out-of-network benefits paid? Is SuperBill worth the investment?
We’ll give you everything you need to know before signing up for a reimbursement service. Let’s get started with a quick list of pros and cons.
SuperBill overview: How they simplify out-of-network reimbursement
SuperBill is a professional out-of-network claim negotiation service. They file for insurance reimbursement on your behalf, taking the complication out of seeing providers that don’t accept insurance or aren’t in your insurance plan’s network.
There are many misunderstandings around in vs out-of-network providers – there’s still a chance that your insurance will reimburse at least some of your money if you file a claim, even if your provider is out of network.
BUT, the reimbursement claims process is complicated and can take a lot of time, especially if the first claim is rejected or if you’re dealing with multiple family members. SuperBill hires professionals with medical insurance experience to:
- Review all medical bills for errors
- Complete and file the necessary reimbursement forms
- Respond to and resolve any reimbursement claim denials
- Maximize your reimbursement amounts
…all on your behalf, saving you time, money, and headaches.
Basically, SuperBill simplifies the out-of-network claims negotiation process by doing it all for you. All you need to do is upload your bills, and they’ll take it from there.
We know that there are lots of questions about how insurance works, to begin with, so let us answer some of those first.
What is out-of-network coverage?
When you visit a doctor or provider from your insurance plan’s approved list, you see an in-network provider. Out-of-network (OON) providers are any providers outside your plan’s approved list.
Health insurance plans develop contracts with medical providers to determine what rates they’re willing to accept as payment. Some plans only cover in-network services, and even if your plan covers out-of-network, it usually covers a lower percentage of the cost.
Always check with your insurance plan to determine the policy for out-of-network providers before scheduling your first OON appointment. You can expect to pay out-of-pocket, but your insurance plan determines how much you pay. Additionally, meeting your deductible can bring the cost of OON services down significantly.
If you want to see providers outside of your current network but your insurance will not cover OON services, you have a couple of options:
- Consider switching to a new insurance plan: Start by comparing plans and rates just as you might compare online life insurance or home insurance plans, and ask your preferred OON providers what insurance plans they accept.
- Negotiate directly with your preferred providers: Many will offer discounted rates if you agree to pay out of pocket rather than filing with insurance. That allows you to keep your current plan and still see the providers of your choice.
But if your insurance plan will process OON reimbursement claims, but the process is complicated, or you don’t believe you’re receiving the right reimbursement rates on your own, SuperBill is a possible solution – they can even help with bills for providers who refuse to accept insurance.
Out-of-network provider benefits: The inadequacy of in-network coverage
All that being said, have you noticed that the in-network providers through your insurance company aren’t always the best options for your healthcare? Insurance companies have been increasing the number of patients on their plans without increasing the number of providers at the same rate.
This can overload to in-network providers can mean:
- Longer wait times for appointments
- Overcrowded waiting rooms with excessive delays
- Providers insisting on only handling one problem or condition per appointment
- Short appointment times that make you feel rushed
What’s happening to our healthcare system? Many providers are opting out of contracts with big insurance companies, and other providers are increasingly being preferred by the insurance based on payment agreements, not the quality or specialty of care.
This can lead to lower-quality healthcare and fewer options for you and your family.
Sound depressing and all too familiar? There’s good news!
Out-of-network claims negotiation: What you’re missing
If your insurance plan does not offer a wide range of providers or services within its network, it may make sense to explore your out-of-network (OON) options.
OON usually includes therapy or other forms of specialized care, such as dietary specialists, chiropractors, psychiatrists, dermatologists, and more. There are benefits to finding a way to see these OON providers, including:
- Greater appointment availability
- More specialized care
- No restrictions from your insurance company in tests and procedures ordered
- Ability to select from all providers to find one that you feel comfortable with and trust
However, there’s also a common misconception that OON services aren’t covered by insurance plans. Many people fail to file for reimbursements that they deserve because they don’t realize it’s an option.
Au contraire! In many cases, insurance companies will reimburse around 50% to 80% of OON bills if you’ve met your deductible. This involves a lot of research into your plan’s policies, finding and filling out the right reimbursement forms (with no errors), and negotiating with insurance or rejection notices, all within a timely manner.
Sounds like a lot, though, right? There are so many opportunities for mistakes in this process that can cost you money, which is why SuperBill is worth the investment to do all of this for you.
How does out-of-network reimbursement work?
If you want to see a provider outside of your insurance plan’s network, you’d need to walk through the following process each time you receive a bill for reimbursement.
- Pay for the services out of pocket.
- Obtain superbill: The provider will give you a superbill, which contains medical codes and other details regarding the services delivered. Make sure you aren’t given a standard bill or just a basic receipt!
- Reimbursement form:: Secure the proper reimbursement form from your insurance company and fill it out completely. Submit it to the insurance company along with your superbill – every company has its own process for submissions.
- Possible resubmission: You may need to fix errors and resubmit to receive the full out-of-network reimbursement rates.
- Possible reimbursement: Wait to see if you receive full, partial, or no reimbursement.
This process can take weeks – even months – to complete, even if there are no hiccups or errors along the way. Some providers may agree to fill out reimbursement forms for you. Others will not, and some may not know any more about those forms than you do.
So, how can SuperBill help with out-of-network reimbursement?
SuperBill is a hands-on team of out-of-network reimbursement specialists who provide around-the-clock support for you and your medical bills and fight for greater reimbursements rate.
Look, not all of us are insurance pros. In fact, many of us avoid the details because it’s simply too much. The process is tedious, and without the right expertise, you might lose hundreds if not thousands of dollars a year that you could’ve been reimbursed.
SuperBill will handle every step of out-of-network claims negotiation for you, all you have to do is sign up for a plan and submit your superbills as you receive them. The process includes the following services for every bill you submit:
- Reviewing: They will check your out-of-network benefits and estimate how much money you can get back
- Maximizing reimbursements: They review your bills for errors to maximize your odds of getting reimbursed by your insurer
- Tracking: Timely file and track claims for you, not missing a single step that you might’ve otherwise overlooked
- Unlimited appeals filing: If your insurer denies your claims, SuperBill will fight back. They’ll review the fine print in your Explanation of Benefits (EOB) and refile appeals, so you don’t have to.
|Monthly plan||Annual plan (20% savings)|
|Individual Plan||$9.99/mo ($119.88/year)||$95.88|
|Family Plan||$24.99/mo ($299.88/year)||$239.88|
How are Out-of-Network Benefits Paid with SuperBill?
Once you sign up with SuperBill, they ensure your claims are free of errors and then process reimbursement claims on your behalf. How can you get started?
- Sign up: After getting started, you’ll fill out a form to register, including your insurance information.
- Verify benefits (optional step): This lets you know what kinds of services are covered under your insurance plan, so it’s a great way to get organized and prepare before your OON service provider visit.
- Once your patient info is added, SuperBill’s team will review your benefits and email you within two days to check out your benefits.
- Choose a subscription: Select a plan best for you or your family from the pricing listed above.
- File a claim: Upload your medical bill(s). SuperBill will use your bills to create and file a claim on your behalf, including negotiation, error-correcting, and any refiling necessary to get your best reimbursement possible.
- Track claims (optional): After filing, you can check the status of the phase your processing is in. They are also available for 24/7 support with any questions or concerns.
These are the same actions you’d have to take when filing for reimbursements on your own. SuperBill allows you to relax while professionals handle every step of the process and get you the most money back possible.
We do want to note that SuperBill can only negotiate payment for superbills that are rightfully owed by your insurance company – they can’t force the insurance company to pay bills that are not covered under any circumstances by the plan.
Negotiating out-of-network reimbursement claims with vs without SuperBill
How much easier does SuperBill make it to get paid back for out-of-pocket medical bills? All of this depends on your insurance, the amount of OON services that you require, and your providers.
SuperBill offers a calculator to estimate your reimbursements for certain types of services, but as an example:
|Without SuperBill||With SuperBill|
|Time for reimbursement||5 weeks – 3+ months||2 weeks – 1 month|
|Usual amount of refiles necessary||2-3||0, they will do it for you|
|Reimbursement amount||$100-$1,000||$300-$2,000 annually|
|Cost||Free to do it yourself||Individual: $9.99/mo or less
Family: $24.99/mo or less
|24/7 support from insurance experts?||❌||✅|
The verdict: Is SuperBill worth it for out-of-network claims negotiation?
If you’re someone who regularly needs to see OON providers, SuperBill is an incredible option to save you time and get you the reimbursements that you deserve. While the final decision is always yours, we believe an out-of-network claims negotiation service like SuperBill is worth the investment if you:
- See OON providers regularly
- Believe you aren’t receiving the full reimbursement you deserve when filing
- Are frustrated and find reimbursement claims forms complicated or stressful
- Don’t have time to track your reimbursement claims, fix errors, and file disputes
- Are unfamiliar with the reimbursement claims process and know you’re missing out on money owed to you
- Have a new insurance plan that doesn’t cover a provider you prefer in-network, and you want to continue seeing them without complicated forms
In those cases, you can save a lot of time, money, and frustration by working with an out-of-network claims negotiation service. SuperBill allows you to submit unlimited claims for one monthly or annual fee. They handle every step of the process and will fight for you if your claim is denied or you don’t receive the full amount owed.
SuperBill FAQs: What to know before getting started
SuperBill can handle virtually any superbill or claim that your insurance company will accept, including (but not limited to):
- Physical therapy
- Speech-language pathology
- Medical specialists
SuperBill works with virtually any insurance plan that offers reimbursement for out-of-network services. If your plan has a reimbursement claims process, they can most likely file on your behalf.
SuperBill is not designed for patients who:
- Are uninsured: you must have an insurance policy for SuperBill to work with
- Do not have any out-of-network benefits- your insurance policy has to have at least some form of OON benefits and coverage for SuperBill to leverage
- Need hospital bill negotiation
- Only need in-network insurance claims- SuperBill can only work with OON claims
- Have Medicaid or Medicare- but they can serve Medicare Advantage patients
Have you or someone you know used SuperBill or another reimbursement service? We’d love to hear about your experience in the comments below!
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