For Patients

Family Health Plan Basics: How to Manage Your Family’s Out-of-Network Insurance Claims

How do family health plans work? Learn how to manage your family’s out-of-network reimbursements with ease with SuperBill.

A family health plan is an absolute must for families with children under the age of 26. Essentially, these plans group your whole family into one health insurance plan. So, you pay a single premium each month, which is cheaper than paying for multiple individual plans. It’s a serious money-saver! When you view family health insurance plan comparisons, consider their out-of-network (OON) benefits. If anyone in your family uses OON providers for their healthcare needs, you will want to select a family health plan with OON coverage! 

Unfortunately, having OON benefits in your family health insurance plan is just the first step. The process of getting reimbursed for OON expenses can be complicated! At SuperBill, we understand the unique struggles families face when it comes to out-of-network claims. In this post, we want to introduce you to SuperBill’s family plans. We’ll show you how we save you time and money for your family’s out-of-network services. But first, let’s dive into the details of family health plans.

How Does a Family Health Plan Save Me Money? 

In a family health plan, the benefits for you, your spouse, and any children under the age of 26 are purchased together. Sometimes, one spouse is on a separate plan they get through work, and the rest of the family is on a family plan. But no matter who is on the family’s plan, you’ll pay one monthly premium.

The cost of this premium does increase as you add family members to the plan. But not as much as buying an individual plan for each family member. Think of buying in bulk. A family medical care plan works the same way—you save money per person by buying more. And some insurance companies charge a flat rate for family plans, regardless of how many children are on the plan. 

If you have three or more family members, purchasing a medical insurance plan for your family is a great deal. That said, it can be a challenge to find the best health insurance plan for family healthcare needs. You need to consider several things: 

  • The monthly premium your family can afford 
  • How high the deductible is - and how much risk you are willing to take
  • The costs for office visits
  • What types of services the plan covers
  • Which providers and facilities are in the insurance company’s network
  • If it includes out-of-network coverage, and how much 

Once you have a family health plan, it’s time to use your benefits! If the whole family is staying in-network all the time, using your health insurance benefits is fairly easy. But here’s where it gets tricky…

Family Health Plan Out-of-Network (OON) Benefits

For some families, it is just not possible to stay in-network for all their healthcare needs. Families may live in an area where there aren’t many providers nearby. The in-network providers in their area may have extensive waitlists. Or, one or more family members may have special health needs that require specialist care. These are just a few of the many reasons families use OON providers.

When using your medical plan for family health expenses, filing your own OON claims is a hassle. While in-network providers have a contract with your insurer and submit claims for you, it’s different with OON providers. You pay for their services up front, and then have to seek reimbursement from insurance. And when you use OON services, the claims are usually left to the patient to file. 

Those OON claims have to be filed, tracked, and tallied to know your progress toward your deductible. If your insurer rejects your claim, you have to correct and refile them to get money back. Staying on top of your spouse’s, children’s, and your own out-of-network claims can get overwhelming very fast.

What if your family is seeing multiple out-of-network specialists? Your claims-filing is likely a mess.

An Example: Managing Multiple Family Members’ Health Claims

Here's an example. Let’s say you see a physical therapist, your spouse sees a therapist, and two of your children see pediatric specialists. And let’s say all these specialist visits are weekly. In this case, you need to file four separate OON claims each week.

At this point, tracking your progress towards your family’s OON deductible will take a spreadsheet! To further complicate things, many family plans have separate deductibles for each family member. Add some more tabs on that spreadsheet.

Once you’ve met the OON deductible in your family medical insurance plan, your insurer will reimburse you for a percentage of your OON services. Great! Except, to get that reimbursement you’ll have to file each of these claims separately. There’s a separate bill from the therapist, each of the pediatric specialists, and the physical therapist. Each of these require action to be reimbursed. It’s up to you to jump through your insurance company’s reimbursement hoops.

If this example seems outlandish, consider the following. In 2018, The National Survey of Children's Health determined that 1 in 5 U.S. children have special health care needs. And that number is growing. More children are seeing pediatric specialists, child psychologists, and physical therapists each year. That's a lot of OON claims. 

The superbills used for OON billing combine multiple services into one bill. They simplify things so that you’re left with fewer bills to send to your insurer. But there’s no way to simplify OON reimbursements across multiple providers and types of care, something crucial for families. Unless you leave it to SuperBill…

How SuperBill Can Help Your Family

At SuperBill, we understand the struggle of submitting claims to insurance for OON services. We see how hard it is for families, and we are here to simplify your reimbursement claims. Our team of insurance experts is available to help your family.

Enter SuperBill’s Family Plan. You pay a single monthly subscription fee for your entire family to use SuperBill’s services. We can assist you in understanding your family health insurance plan and see where you stand with your OON benefits. We will file all your family’s out-of-network claims. We will follow up with your insurance company and fight your insurer for reimbursement. All you have to do is upload each family member’s superbills, and we’ll take care of the rest.

With SuperBill’s family plan, you get access to an online portal that you can check 24/7. On the portal, you can check the status of each family members’ claims. You can also check each person’s benefits including your progress towards your OON deductible. It truly has everything you need in one place.

With SuperBill’s Family Plan, there's no limit to the number of family members you can include. There's room for the whole family! Don't waste your energy tabbing through spreadsheets managing your family healthcare costs. Let SuperBill save you time and money on your family's OON reimbursements today.

Want to Learn More?

If you’re curious about how SuperBill works, check out our post on Getting Started with SuperBill. For more information about superbills and how they're reimbursed, take a look at The Complete Guide to Superbills.

And finally, learn about copayments, coinsurance, out-of-pocket maximums, and more with our Complete Guide to OON Reimbursement. Power to the patient!

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This post was written and researched by
Harrison Caruthers

Harrison Caruthers (he/him) is a software developer in the Bay Area. Before SuperBill, he worked as an engineer for Amazon in Madrid. While in Spain, Harrison developed an appreciation for both Mediterranean cooking and simplified healthcare systems. He returned to the Bay to co-found SuperBill with fellow Stanford grad Sam Schwager after mounting frustrations with US insurance networks.