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For Providers
How to Explain Superbills and OON Reimbursement to Your Patients
For Providers

How to Explain Superbills and OON Reimbursement to Your Patients

Why OON Reimbursement Needs Improvement

Billions of dollars are left on the table every year because patients misfile their superbills. Whether it’s due to exhaustion, overwhelm, or a misunderstanding of the process, it all amounts to more stress for your patients, and ultimately, more work for you. Communicating how superbills and out-of-network reimbursement work to your patients in a clear, effective manner will save everyone involved some hassle.

We know that OON reimbursement for superbills can be complicated, and you often lack the time to launch into detailed explanations about the process to your patients. This post will provide you with resources to help you define superbills and OON reimbursement in a succinct, straightforward manner. Our goal is to help your office’s reputation for transparency and save you time that would be better spent with patients.

Use this post as a reference before meeting with your patients to talk about their superbills, or feel free to copy and paste sections from it to share in your communications with patients. You could also link them to one of our For Patients posts, like The Complete Guide to Out-of-Network Reimbursement or The Complete Guide to Superbills.

Now, here are the main points to keep in mind when discussing OON reimbursement with your patients.

1: Define “Superbill” 

Superbills are a new concept for a lot of patients. Although they’re not overly complicated, we find it’s useful to start small with a definition of superbills, just to make sure everyone’s on the same page. Most patients are used to in-network billing and understand why a superbill looks like it does, but newcomers might not know the difference between superbills and regular medical bills. 

The key difference, of course, is that superbills have already been paid. We find it helpful to compare superbills to itemized receipts. Everyone uses receipts and understands them to describe things that have already been paid for. However, if you make this comparison, be sure to stress that unlike receipts, your patients need to do something with their superbills, namely, send them to their insurance. A lot of people throw away their receipts right after getting them, but they shouldn’t throw away their superbills! They’ll need them to file a claim.

For a shortcut to defining superbills, send your patients to our What Is a Superbill post. All the essential information for a newcomer to superbills is housed there. 

2: Determine Who’s Filing the Claim

One of the most common causes of misfiled or neglected superbills is patients thinking that they don’t have to file their superbills themselves. If you’re filing on their behalf, let them know. If you’re not, let them know twice. But be careful when giving your patients superbills to submit; superbills given to patients are rarely reimbursed.

If they seem at all unsure of how to file their claim, walk your patient through the items in their superbill and provide them with steps for filing it. This might be a good time to share a supplementary resource, like our Complete Guide to Superbills. It might also be a good time, if they appear distracted, to remind them that they don’t get paid if no one files

You could also save yourself the hassle and have SuperBill file it. Think of SuperBill as a ferry connecting you, your clients, and their insurance payers. With the ferry running, you no longer have to spend the energy bridging the gap yourself. You can stay right where you’re needed most: in the profession you trained for, providing quality healthcare.

3: Explain What Happens After a Claim Is Filed

People can get impatient when waiting for their reimbursements. All that means is more calls to your office slowing things down. A clear explanation of how superbills are reimbursed will almost certainly save you time and stress. Reimbursements usually take at least 30 days, but they can sometimes take as long as 90. Remind your patients that the process takes time. If needed, explain the insurer’s side of the process, which we’ve outlined below.

After the insurer receives a claim, they decide whether to reimburse the claim in total, in part, or not at all. Insurers use remittance advice codes to convey their reasoning behind healthcare reimbursement rejections. Whoever filed the claim, whether it’s the provider or the client, has to review these codes to determine if resubmission is merited.

Sometimes, a slight error in the claim can be corrected, and the claim can be resent without much hassle. But in other cases, insurers give more complex reasons for rejections. They might reject a claim due to the timing of the service rendered, the grouping of non-compatible services into a single bill, noncoverage of said services, or any number of reasons, leaving the filer wondering whether to refile, and if so, what to correct.

It’s helpful to remind your clients that healthcare reimbursement is often a shared responsibility between insurers and clients, especially when filing for out-of-network benefits. Many clients will owe a copayment, coinsurance, and/or deductible amount that could leave them confused if they’re not expecting it. 

4: Have a Plan In Case Claims Are Rejected By Insurance

The difficulty of claims submissions is probably the most important point to drive home when speaking with your clients about their superbills, because so many clients give up after their first claim is rejected. Help them understand that refiling is a part of the process, and you’ll likely save them money.

Additionally, come up with a plan for rejected claims. What sections might be rejected, and what can you do about it? How many times are you willing to refile to get the maximum allowed amount? If your patient is handling the first filing, could you handle the refiling, or vice-versa? 

Here at Superbill we make sure to refile claims repeatedly until your client receives the best reimbursement they can get from their insurer. Persistence is key in this system; Superbill won’t stop until your client gets the reimbursement they deserve. If you want to skip all four steps, knowing your patients’ reimbursements are in good hands, all you have to do is enter your email and click Get Started.

If you'd like to know more about how to start uploading superbills to our portal, read Getting Started with SuperBill. For medical coding tips and best practices, check out our post on CPT and ICD-10 Coding.

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About the Author

Sam Schwager

Sam Schwager co-founded SuperBill in 2021 and serves as CEO. Having personally experienced the frustrations of health insurance claims, his mission is to demystify health insurance and medical bills for other confused patients. Sam has a Computer Science degree from Stanford and formerly worked as a consultant at McKinsey & Co in San Francisco.