Your insurance may reimburse you for an out-of-network provider visit, but it depends on your plan. Here’s how it works and what you need to do:
1. Check Your Insurance Policy
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.
2. What You Need from Circle Medical
Ask for a detailed receipt (superbill) by messaging the support team in our mobile app.
2.1 What Is an Itemized Receipt?
An Itemized Receipt ( or known as a superbill) is a detailed document you can submit to your insurance for reimbursement. It includes information about the services you received, the costs, and the medical codes. While we’re happy to provide it, your insurance will decide whether or not to cover the costs based on your plan.
After your appointment, we can provide an Itemized Receipt that lists the services you received, which you can send to your insurance company for reimbursement. Your insurance will decide whether or not to cover the costs based on your plan.
3. How to Submit a Claim
Go to your insurer’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.
4. What to Expect
Processing can take 4-8 weeks.
Your insurer will send an Explanation of Benefits (EOB) detailing how much they covered.