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Will my insurance reimburse a self-pay appointment?
Will my insurance reimburse a self-pay appointment?
Updated over a week ago

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 a 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 in our mobile app.

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.

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