The short answer: A superbill is a detailed receipt you can send to your insurance company after you pay for a visit yourself. If your plan has out-of-network benefits, your insurer may pay you back for part of the cost. At Neurokin, you get a superbill after every visit.
Why some practices don't take insurance
Insurance often pays for short visits. A careful adult ADHD or autism evaluation takes hours, over several visits. Many specialty practices, including ours, choose not to bill insurance so they can spend the time a good evaluation needs. A superbill helps close the gap.
What is a superbill?
A superbill is a receipt with the details your insurance company needs to process a claim. It usually includes:
- Your name and date of birth
- The date of your visit
- The clinician's name, license, and NPI number
- The practice's address and tax ID
- Codes that describe the visit (CPT codes)
- Codes that describe the reason for the visit (diagnosis codes)
- What you paid
Step 1: Check your out-of-network benefits
Call the number on the back of your insurance card. Ask:
- "Do I have out-of-network benefits for outpatient mental or behavioral health?"
- "What is my out-of-network deductible, and how much have I met this year?"
- "After my deductible, what percent do you reimburse?"
- "Do you need pre-approval for psychological or neuropsychological testing?"
- "How do I submit a claim, and is there a deadline?"
Write down the date, the name of the person you spoke with, and a reference number.
Good to know: PPO plans often include out-of-network benefits. HMO and EPO plans usually don't. Medicaid and Medicare usually won't reimburse out-of-network care.
Step 2: Pay for your visit
At Neurokin, you pay for one visit at a time, on the day of the visit. HSA and FSA cards can be used for all of our services.
Step 3: Get your superbill
We send you a superbill after each visit through the patient portal.
Step 4: Submit your claim
Most insurers let you submit a claim online, through their app, or by mail. You'll usually need to fill out a short claim form and attach the superbill. Keep a copy of everything.
Step 5: Follow up
Claims can take a few weeks. If you don't hear back, call your insurer with your claim number. If a claim is denied, ask why. Sometimes it's a simple fix, like a missing form.
Will I get money back?
It depends on your plan. Things that affect your payback include your out-of-network deductible, your coinsurance, and what your plan considers the "allowed amount" for each service. Some people get a good share back. Others get little or nothing until their deductible is met. Calling your insurer first is the best way to know what to expect.
Other ways to manage the cost
- HSA or FSA: use pre-tax dollars for your visits.
- Pay per visit: you don't pay for the whole evaluation up front.
- Good Faith Estimate: under federal law, if you pay for care yourself, you have the right to an estimate of your expected costs before your visit.
Questions?
See
our pricing or call us at
(908) 215-2331. We're happy to help you figure out what to ask your insurance company.
Sources
This article is for education only. Insurance benefits vary by plan. Check with your insurance company about your coverage.
