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How to Use Your Superbill for Out-of-Network Reimbursement

We're an out-of-network practice, so we don't bill your insurance directly. After you pay, we give you a superbill: an itemized statement with the codes insurance companies ask for. You can send it to your insurance company yourself. Whether you're reimbursed, and how much, depends on your plan. Here's how to find out, and how to submit it.

Step by step

  1. Know your plan type. HMO and EPO plans usually don't cover out-of-network care except emergencies. PPO plans let members see out-of-network providers at an additional cost.
  2. Look up “Chiropractic care” in your Summary of Benefits and Coverage, and try your insurer's online cost estimator.
  3. Call the member services number on the back of your insurance card and ask the questions on this page. Write down the rep's name, the date and the call reference number.
  4. After your visit, get your superbill from our front desk, the same day or as a monthly statement.
  5. Log in to your insurer's member portal and choose “Submit a claim,” or download their member medical claim form.
  6. Fill in the member section. Leave the “pay the provider” or assignment of benefits section blank, because you've already paid us.
  7. Attach your superbill and proof of payment. Keep copies of everything.
  8. Upload it, or mail it to the claims address on your insurance card.
  9. Send it in monthly, or as soon as you can. Deadlines vary by plan, and some plans require claims within 90 days.
  10. Watch for your Explanation of Benefits (EOB). If a claim is denied, call your insurer, ask why, and ask about the appeal process.

Questions to ask your insurance

  • Is my plan an HMO, EPO, PPO or POS?
  • Do I have out-of-network benefits for chiropractic care (codes 98940 to 98942, place of service 11)?
  • What is my out-of-network deductible, and how much have I met this year? When does my plan year reset?
  • What coinsurance do I pay after the deductible?
  • What is my out-of-network out-of-pocket maximum?
  • Is there a yearly limit on chiropractic visits?
  • Do I need a referral or prior authorization?
  • Is my chiropractic benefit managed by another company?
  • How do I submit a claim myself, and which form do I use?
  • What is my filing deadline?
  • Will any payment come to me or to the provider?

What you'll need

  • Your superbill from our office (it lists dates, codes, charges and what you paid)
  • Proof of payment, such as your receipt
  • Your insurer's member claim form, if they use one
  • Your member ID from your insurance card