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If your insurance plan is not one I am directly in-network with, you may still be able to get partial or full coverage for our sessions using an out-of-network superbill.
Below is a step-by-step guide on what a superbill is, how to check your coverage beforehand, and how to submit it to your insurance company.
What is a Superbill?
A superbill is an itemized receipt given to you after your appointment. It contains all the necessary medical coding—such as CPT codes (procedure codes) and ICD-10 codes (diagnosis/medical necessity codes)—along with provider credentials and billing details that your insurance provider requires to process an out-of-network claim.
3 Simple Steps to Get Reimbursed
1. Pay for Your Session Upfront
You pay the standard private-pay fee at the time of your service using cash, credit, or HSA/FSA funds.
2. Receive Your Superbill
After your appointment (or at the end of the month), I will provide you with a downloadable superbill through the client portal.
3. Submit to Your Insurance Provider
Log into your insurance portal, upload the superbill alongside their out-of-network claim form, and submit it for processing. If approved, your insurer will mail you a reimbursement check directly or apply the amount to your out-of-network deductible.
Questions to Ask Your Insurance Before Your First Appointment
To avoid surprises, it’s best to call the customer service number on the back of your insurance card before our first session and ask these questions:
- Out-of-Network Benefits: “Do I have out-of-network benefits for outpatient nutrition counseling?”
- Deductible: “Do I have a separate out-of-network deductible, and how much of it have I met so far this year?”
- Reimbursement Rate: “Once my deductible is met, what percentage of the allowed amount is reimbursed for CPT code 97802 (initial assessment) and 97803 (follow-up)?”
- Diagnosis Requirements: “Does my plan require a specific ICD-10 medical diagnosis code from a physician to qualify for reimbursement?”
- Submission Method: “How do I submit an out-of-network claim? (Online portal, mail, or app like Reimbursify?)”
Please Note: A superbill does not guarantee that your insurance company will reimburse you. Coverage depends entirely on your specific insurance plan and out-of-network benefits. Payment for services is due at the time of care regardless of insurance reimbursement outcomes.
