Even if you are not an in-network provider with health insurance companies, a client may still request a ‘superbill’ from you so they can submit a claim on their own behalf for reimbursement.
So what is a superbill?
A superbill is an itemized receipt form that describes rendered medical services to healthcare providers. It provides the data needed for a patient to submit their own healthcare claim to their health insurance plan for reimbursement, that includes:
Provider office address
Provider phone/fax #
License # (if applicable)
SSN or EIN # (If you do not have an EIN, you will have to provide your highly-sensitive SSN...a good reason you should form a legal business entity!)
Date of service
Diagnosis code (ICD-10)
Procedural CPT code (for example, 97802 for initial assessment)
Number of units (one unit = 15 minutes, so 60 minute session = 4 units)
Fee for service
Offering superbills as an out-of-network provider is a convenient avenue for insurance without being directly contracted with a health plan.
However, it is not a sustainable, long-term strategy because:
Potential clients are more likely to go with in-network dietitians where there is full coverage or a low-co-pay for a number of sessions.
Out-of-network providers may not be covered by health plans at all.
Most potential clients often do not want to go through the trouble of finding out their out-of-network coverage or submitting their own claims.
Visit Healthy Bytes if you’re considering becoming an in-network provider with an improved reimbursement process that benefits both you and the client in the long run!