Out-of-Network Insurance Claim

Depending on the type of insurance plan you have, you may have out-of-network (OON) benefits. OON benefits are usually only offered by PPO-type insurance plans. HMO and EPO plans do not offer OON benefits. You can check your insurance care to see which type of plan you have.

What is a "Superbill"?

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· A superbill is a form completed by mental health practitioners that allow patients to be reimbursed directly from their health insurance companies.

· A superbill contains information about you, the service you received, the cost of the service provided, and your diagnosis.

· A superbill does not guarantee that an insurance provider will pay for the services provided.

· Each insurance plan is different, and it is your responsibility to contact your insurance provider and find out exactly what will be covered.

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How do I find out what my insurance company will reimburse for an out-of-network provider?

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· Call the customer service phone number listed on your insurance card.

· Ask, “I want to work with an out-of-network mental health provider, how much will you reimburse me?”

· Ask, “What is the best way to submit my claim with a superbill?”

· Ask, "Do I need prior authorization for any mental health out-of-network claims?". Submit any information for prior authorization.

· Be sure that your benefits are clear to you.

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Release of Information

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Be aware that should you choose to submit a superbill, you are releasing medical information that is protected by law. This means you are waiving some of your rights to privacy and confidentiality. It is standard for your insurance company to keep a record of your diagnoses stated on the superbill as part of your permanent medical file. An insurance company can request information from your patient records related to any claims you submit. 

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How will I get my superbill after each session?

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After each session with your provider, a superbill is automatically added to your account in the Client Portal. You may log into the portal at any time to access your billing documents. You may download any of your billing documents in electronic format.

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How long does it take for an insurance company to reimburse me for these claims?

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First, the insurance company must approve your claim. If they do not approve your claim they will notify you as to why they have denied it. You may need to resubmit the claim if this occurs. Payment times vary widely depending on the insurance company. OON claims submitted electronically through your insurance companies client portal are usually processed within 14 business days. The insurance company then mails you a check for the amount of reimbursement you are entitled to under your plan.

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Will O'Brien & Associates submit an OON claim for me?

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No, at this time, we do not submit any insurance claims for clients. 

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