Guides · Insurance coverage

What is a superbill and how do you submit one?

A superbill is an itemized form from a provider that lists what was done and why, using the procedure and diagnosis codes an insurer needs to process a claim. You use it when you pay a provider yourself, usually an out-of-network one, and then ask your plan to pay you back.

A superbill isn't a claim by itself. You send it with your plan's claim form. What comes back depends on your out-of-network benefits, your deductible and the plan's allowed amount, not on what the provider charged.

Updated · Facts checked against the sources listed below

What's on a superbill

  • Patient details: your name, date of birth, address and insurance member ID.
  • Provider details: name, credentials, practice address and phone, and the provider's National Provider Identifier (NPI), a unique 10-digit number used to identify health care providers in standard insurance transactions.
  • Date and place of each service.
  • Procedure codes (such as CPT codes): what was done, such as an office visit or a specific test, with units.
  • Diagnosis codes: why it was done. Each procedure should link to a matching diagnosis, because mismatched codes can get a claim denied.
  • Fees: the charge for each service, the amount you paid and any balance.

If any of these are missing, ask the office to add them before you submit. A plain credit card receipt usually isn't enough.

How to submit a superbill to your insurer

  1. Check your out-of-network benefits first. Call the number on your card or read your plan's summary. Ask whether you have out-of-network coverage, your out-of-network deductible and coinsurance, and how the plan sets its allowed amount.
  2. Get the plan's claim form. Most insurers have a member reimbursement form on their website or member portal, and many accept uploads.
  3. Fill in the form and attach the superbill. Keep your original and send copies.
  4. Submit within the plan's filing deadline. Your plan documents say where to file and any time limit. Original Medicare, for example, requires claims within 12 months of the service date.
  5. Watch for the Explanation of Benefits (EOB). For employer plans covered by federal rules, a decision on a claim for care you've already received is due within 30 days, with one possible 15-day extension.

How much you get back

Your plan pays based on its allowed amount, the most it will pay for a covered service, not the provider's full charge. You usually pay your deductible first, then out-of-network coinsurance on the allowed amount, which is typically a higher percentage than in network. You remain responsible for any difference between the provider's charge and the allowed amount.

If the claim is denied or underpaid, you can appeal. See how to appeal a health insurance denial and how out-of-network reimbursement works.

Superbills, Medicare and HSA or FSA

With Original Medicare, providers who take Medicare are supposed to file the claim for you. If they refuse, you can file yourself with the Patient Request for Medical Payment form (CMS-1490S) and the itemized bill. Providers who have opted out of Medicare can't be paid by Medicare, so a superbill won't help there except in emergencies.

A superbill is also good documentation if you pay with HSA or FSA funds and your plan administrator asks for proof of a medical expense. See what is HSA eligible.

How Gabriel helps

Gabriel finds and books root-cause and holistic practitioners, such as naturopaths, acupuncturists, chiropractors and functional medicine doctors, and files superbills for out-of-network reimbursement. Your own plan decides what it pays back. Gabriel membership is not health insurance.

Common questions

What is the difference between a superbill and an itemized bill?

An itemized bill lists each charge. A superbill is an itemized bill that also includes the procedure and diagnosis codes and provider details an insurer needs to process a claim.

Can I submit a superbill to insurance myself?

Yes. Attach it to your plan's member claim form and send it by the method your plan accepts, usually mail, fax or the member portal.

How long does superbill reimbursement take?

Employer plans under federal rules generally must decide a claim for care already received within 30 days, with one possible 15-day extension. Payment timing after approval varies by plan.

Will my insurance reimburse the full amount on the superbill?

Rarely. Plans pay a share of their allowed amount after your out-of-network deductible, and some plans have no out-of-network benefits at all.

Does Medicare accept superbills?

If a provider who accepts Medicare won't file, you can send Medicare the CMS-1490S form with an itemized bill within 12 months of the service. Medicare won't pay providers who have opted out, except in emergencies.

Sources

  1. In Search of a Super Superbill Family Practice Management, American Academy of Family Physicians
  2. NPIs Centers for Medicare & Medicaid Services
  3. How do I file a claim? Medicare.gov
  4. Does your provider accept Medicare as full payment? Medicare.gov
  5. Filing a claim for your health benefits U.S. Department of Labor, EBSA
  6. Allowed amount (glossary) HealthCare.gov

This guide is general information, not medical advice. It does not replace a visit with a licensed clinician. Gabriel membership is not health insurance.