Out-of-Network Superbills 101
What is a superbill and when will I need one?
Typically, you’ll need to ask for a superbill from a provider who is out-of-network with your insurance plan in order to request reimbursement for some portion of these services. For example, if a therapy provider your child sees is not contracted with your insurance plan and they require payment at the time of your child’s therapy visit, you can ask for a superbill and submit it along with your claim to your insurance.
In short, a superbill is not just a paid invoice; it is a medical receipt that the health plan will accept for processing out-of-network services because it contains specific medical information, such as a billing code and diagnosis code, identifying information for the provider, and your child’s full legal name.
Undivided's Director of Health Plan Advocacy, Leslie Lobel, explains more in this clip:
What should be included in a superbill?
To make sure the reimbursement process goes smoothly, here are the elements you should expect to see on a superbill:
- Child’s full name as it appears on the health plan ID card (not parent’s name) or a nickname
- Child’s home address
- Child’s date of birth
- Provider Name
- Full Address
- Tax ID (EIN)
- NPI number (National Provider Number)
- License number
- Diagnosis and diagnosis code
- Procedure code/CPT Code/For Service Rendered — This is a five-number code that may have an alpha suffix
- Dates of service
- Place of service — This is often a two-letter code (office, home, school, clinic)
- Amount charged for each service
To learn more about submitting claims for reimbursement, how to work with your health plan, and what to do when a claim is denied, read Insurance Claim Denials and Appeals 101.