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 team 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.