Insurance reimbursement guide
Navigating the U.S. healthcare system can be as challenging as finding your way through a maze, and the insurance process is no exception. Here are the four key steps in the insurance reimbursement process:
1. Call your insurance company for pre-approval
Pre-approval/pre-authorization is basically your insurance company saying, “We looked into this, and we’ll (partially) cover it!” Typically, they’ll give a percentage or exact amount that they’ll pay, which takes the guesswork out of seeing an out-of-network provider.
To get pre-approval, you’ll call your insurance provider’s customer service line. There’s a couple questions you need to confirm before asking them to start the pre-approval process:
Do my benefits cover out-of-network providers?
Do I need a referral from an in-network provider to see someone out-of-network?
How much of my out-of-network deductible is remaining? Note, your deductible is the amount you have to pay out-of-pocket annually before you insurance kicks in. For example, if your deductible is $1,000, your insurance will only start paying once you’ve cumulatively paid $1,000 toward covered services that year.
Once you have this information, tell the representative that you’re looking to get pre-approval to see a provider. They’ll ask you for details on the provider, practice, and services you’re planning to receive. Once you give them that information, they’ll look into your request and contact the provider directly to get any other information they need. Most companies complete their pre-approval process within a week, but you can always ask them to confirm their timeline for investigating.
Lastly, if you are pre-approved, make sure you get it in writing!
2. Book an appointment with your provider
You’re probably familiar with this one. Just hit “Book” on your Provider Matches!
3. Pay and request a superbill
Note that you’ll pay the full cost of your appointment out-of-pocket. When you pay, you should also request a superbill, which is needed for insurance reimbursement.
A “superbill” is basically just a detailed receipt. It explains to your insurance company what diagnoses were addressed and procedures performed.
4. Submit a claim to your insurance company
The easiest way to submit a claim with most insurance companies is through an online portal. Your claim will involve submitting your superbill and proof of pre-approval.
If you have any trouble submitting your claim, just call the customer service line for your insurance provider!