Your insurance may reimburse you for an out-of-network provider visit, but it depends on your plan’s benefits and coverage. Here’s how it works and what you need to do:
1. Check your insurance benefits
Look for out-of-network benefits in your plan. Many PPO plans offer partial reimbursement for out-of-network care.
Check if there’s an out-of-network deductible. Most plans require you to pay a certain amount out-of-pocket before they start reimbursing.
Look at coinsurance rates, for example, if your plan covers 60% out-of-network, you’ll be reimbursed for 60% of the allowed amount, not necessarily what you paid.
Tip: If you are unsure, you can call your insurance and ask whether out-of-network telehealth visits are eligible for reimbursement.
2. Request your itemized bill via chat
After you’ve confirmed with your insurance that you have out-of-network benefits, you may need an itemized bill or superbill from us. To request one, simply start a chat in the app or web portal with our Care Team after your appointment is complete and provide the specific appointment date you need documentation for.
What is an itemized bill?
An itemized bill (also known as a superbill) is a detailed document that includes information about the services you received, the costs, and the associated billing codes. You can submit this document to your insurance company to request potential reimbursement. While we are happy to provide this after your appointment is finalized, please note that your insurance provider determines all coverage and reimbursement based on your plan.
3. How to submit a claim
Go to your insurance’s website and find the out-of-network claim form.
Fill out the form with your details and attach the superbill.
Submit the claim via an online portal, mail, or fax, depending on your insurer’s process.
If you aren’t sure where to send your claim, please call your insurance using the member services number on the back of your card. They can guide you through the process!
4. What to expect
Processing can take 4-6 weeks.
Your insurance will send an Explanation of Benefits (EOB) detailing how much they covered.