Frequently Asked Questions

We named our company Suprabill after the superbill your doctor provides after a medical visit. A superbill is a detailed receipt that includes the date of service, diagnosis codes, and your provider's name and address. It's essential for submitting claims to your health insurance and getting reimbursed.

Please click 'File a Claim' in the navigation bar. You'll be prompted to create a username and password. Once that's done, you are ready to upload your claims for submission.

Once you're logged in, upload your superbill either by uploading a photo or file to the portal or forwarding it to [email protected]. We'll handle the rest and keep you updated as your claim moves through the process.

Suprabill is primarily designed for medical claims, including out-of-network services such as therapy, psychiatry, nutrition, and other health-related care. Many preventive services are often not reimbursed by insurance whether in or out-of-network.

Yes. Suprabill can submit all the charges listed on a single superbill, even if they include multiple dates or different services. It's common to see the same provider more than once or receive several services in one visit. All you have to do is upload your superbill and we'll create and submit individual claims for each billable service.

Yes. You can submit older superbills through Suprabill as long as they are within your insurance company's filing deadline. Most plans allow anywhere from 90 to 365 days from the date of service, but this can vary. We recommend reviewing your plan documents or calling your insurance provider to confirm how long you have to submit out-of-network claims.

If you're filing a claim under a previous insurance policy that has unsubmitted claims, create a new Suprabill account using a different email address.

If you have a new insurance policy, simply update your insurance information in your existing account before submitting your next claim.

Log into your account and click on 'Claims' in the navigation bar. Any draft claims will be listed under the 'Drafts' folder. Click on 'review', complete missing information, and continue along the steps.

Out-of-network providers, like doctors or hospitals, don't have a contract with your health insurance company. In contrast, in-network providers do, which means your care is covered according to your plan's benefits, such as copays and coinsurance.

If your doctor doesn't have an agreement with your insurance company, they won't bill them directly. Instead, you'll need to pay out of pocket at the time of your visit and then submit a claim to your insurance for possible reimbursement.

Health insurance plans are not required to cover out-of-network care, but many do have a process for handling it, especially if the services would be covered in-network. It's important to review your benefits carefully. You need to look for any coinsurance related to out of network care and check whether there is a separate deductible, which is often the case.

PPO (Preferred Provider Organization) and POS (Point of Service) plans typically do include out-of-network coverage.

HMO (Health Maintenance Organization) and EPO (Exclusive Provider Organization) plans typically do not cover out-of-network care unless an exception applies.

Sometimes. These exceptions may be possible:

• Continuity of care if you're mid-treatment and your provider leaves the network
• Network inadequacy (no in-network provider available)
• State-mandated exceptions depending on your location

Note: These exceptions usually require documentation and prior approval.

Suprabill is a medical billing service that helps patients submit out-of-network claims for reimbursement. While Suprabill does not maintain a public list of specific insurers, it can submit claims to most major commercial insurance companies, including:

• Aetna
• Blue Cross Blue Shield
• Cigna
• UnitedHealthcare
• Humana, and many others.

These insurers typically allow patients to file for reimbursement of services received from out-of-network providers, as long as the plan includes those benefits.

Important Eligibility Note

Suprabill can only submit claims to insurance plans that offer out-of-network reimbursement. That means we generally cannot submit to:

• Traditional Medicare (Parts A & B)
• Medicaid
• Worker's Compensation insurance
• HMO plans without OON coverage
• EPO or other limited-network plans without out-of-network benefits

The amount you'll be reimbursed depends on several factors, including your specific insurance plan, whether you've met your out of network deductible, and how your insurer calculates reimbursement.

Some plans base reimbursement on the "usual and customary rate" for a given service in your geographic area, often using zip code and service type as benchmarks. Others may reimburse based on a percentage of Medicare rates or apply coinsurance after the deductible is met. To estimate your reimbursement, you can:

• Review your plan's out of network benefits
• Check your deductible and coinsurance amounts
• Contact your insurance company for a benefit breakdown using the CPT code and provider zip code

Suprabill cannot guarantee or estimate your reimbursement amount. We recommend contacting your insurance provider directly. They can give you the most accurate information based on the CPT code, provider's zip code, and your plan's specific out-of-network benefits.

One common out-of-network benefit we see is when an insurer reimburses a percentage, typically 60 to 80 percent, of the allowed amount. This allowed amount is often less than what your provider actually charged. Reimbursement usually begins only after you have met your out of network deductible.

Example:

• Your provider charges: $200
• Your insurer's allowed amount for that service: $120
• Your plan reimburses: 70% of allowed amount
• You receive: $84 (70% of $120)
• You owe: $116 (the remainder of the $200)

It's important that the bill you receive from your healthcare provider has all the required fields for your claim to be processed as fast and as correctly as possible. At minimum, the following fields should be present:

• Patient's full name
• Provider's full name and credentials
• NPI (National Provider Identifier) — a 10-digit ID issued by CMS (Centers for Medicare & Medicaid Services) used to identify healthcare providers in the U.S.
• Provider's Tax ID (TIN or EIN) — used by insurers to issue payment
• Provider's address and phone number
• Organization NPI — optional, for group practices or clinics
• Date(s) of service
• Place of Service Code (POS) — a 2-digit number indicating where the service took place (e.g., 11 = Office, 02 = Telehealth)
• CPT code(s) — 5-digit procedure codes for what service was provided (e.g., 90834 = 45-minute psychotherapy)
• Modifier(s) — 2-character codes added to CPTs to describe specifics of service (e.g., 95 = Telehealth, GT = Audio/video session) This is optional
• Diagnosis code(s) — ICD-10 codes explaining the medical reason for the visit (e.g., F32.1 = Major depressive disorder, moderate)
• Units — the number of times the service was provided (e.g., 1 unit per session)
• Amount charged or paid
• Indication that the patient paid (e.g., "Paid in Full" or receipt). Some insurers may require this.

Insurance companies use the codes and information on the superbill to determine how much to reimburse you. Missing or inaccurate details can lead to claim denials or delays.

A diagnosis code explains the medical or mental health condition your provider treated during your visit. These codes follow the ICD-10 format (International Classification of Diseases, 10th Revision) and are required by insurance companies to process claims.

Format
ICD-10 codes are usually a mix of letters and numbers, typically in this structure:

A00.0, F32.1, R51

Examples
F32.1 — Major depressive disorder, moderate
F41.1 — Generalized anxiety disorder
R51 — Headache
K21.9 — Gastroesophageal reflux disease (GERD), unspecified

Your provider includes the appropriate diagnosis codes on your superbill. You don't need to know them in advance. Just make sure your superbill is complete when uploading to Suprabill.

A CPT code (Current Procedural Terminology) is a standardized code used to describe the medical, mental health, or therapy services and procedures you received. Insurance companies use these codes to process claims and determine reimbursement amounts.

Format
CPT codes are five-digit numeric codes.

Examples
90834 — 45-minute individual psychotherapy
90847 — Family therapy with the patient present
99213 — Office visit with a primary care doctor (established patient)

A modifier is a two-character code (letters or numbers) that gives extra information about the service performed. It's added to the CPT code to clarify how the service was provided.

Example with Modifier 90837-95

90837 = 60-minute psychotherapy session
95 = Service was provided via telehealth

Modifiers are important because they help insurers process claims accurately especially when services are delivered in nontraditional ways (like virtual visits).

Your health insurance company uses CPT codes as a standardized way to identify the services you received, determine whether they're covered under your plan, and process your claim for reimbursement. It's important that your provider uses the correct code at the time of your visit. CPT codes are also used for administrative purposes such as claims processing and establishing guidelines for medical care review. Developed by the American Medical Association, CPT terminology is the most widely accepted medical coding system in the United States. It's used to report a broad range of services including medical, surgical, radiology, laboratory, anesthesiology, genomic sequencing, and evaluation and management (E/M) across both public and private insurance programs.

Most insurance companies require the provider's NPI (National Provider Identifier) to process out-of-network claims. If it's missing, your claim may be delayed or denied.

We recommend reaching out to your provider and asking them to include their NPI on the superbill. It's easy and free to obtain, and most providers are happy to get one to help their patients receive reimbursement.

They can apply for an NPI at https://nppes.cms.hhs.gov

Suprabill charges $4, billed through Stripe. This charge is per visit (or date of service) per patient, regardless of how many services were performed during that visit. This fee covers the processing and submission work done on your behalf.

When you're ready to pay for your claim, you'll be directed to Stripe's checkout page. There, you can enter your promo code before completing the payment. If you have any issues, just reach out and we'll help.

You can update your card the next time you file a claim. When you submit a new claim, you'll be prompted to enter your payment information. Payment is handled securely through Stripe, and we never store your card details

Suprabill supports one insurance plan per account. Click on 'Profiles' from the navigation bar and the click 'Edit' under the 'Insurance Information' section. We do not support secondary insurance at this time. If your dependent has a different insurance provider then you will need to have a separate account to submit their claims.

Go to the navigation bar and click 'Profiles' and then click on 'Add Member'. You'll be able to manage claims for dependents or spouses from the same account as long as they are on the same health insurance plan.

A deductible is the amount you must pay out of pocket for medical services before your insurance starts covering costs. For example, if your deductible is $1,000, you pay the first $1,000 of your medical bills yourself.

Most insurance plans have two separate deductibles:

In-network deductible applies when you see providers who have a contract with your insurance company.

Out-of-network deductible applies when you see providers who don't have a contract with your insurance company.

You usually have to meet each deductible separately. Hitting one doesn't count toward the other.

Out-of-network deductibles are usually higher than in-network. Sometimes they're twice as much or more than your in-network deductible.

The allowed amount is the maximum dollar value your insurance plan will recognize for a specific service. It determines how much they'll reimburse and how much you may owe. This figure is usually lower than what an out-of-network provider charges. It may also be called

• Eligible expense
• Negotiated rate
• Usual and customary fee (UCR)
• Recognized charge

All of these charges refer to the amount your insurance deems reasonable for the service provided.

Sure! Let's say your provider charges $200 for a session. Your insurance plan considers $120 to be the allowed amount. If your plan covers 80% of out-of-network services, they'll reimburse $96 (80% of $120), and you'll owe the remaining $104 (including the $80 over the allowed amount).

Insurance companies use their own internal pricing models or external benchmarks. One commonly used source is the FAIR Health database, which provides regional cost estimates. You can explore it here as follows:

https://www.fairhealthconsumer.org/

It determines your reimbursement, your out-of-pocket costs, and whether it's worth appealing a claim. Understanding allowed amounts gives you more control when dealing with out-of-network providers.

Yes. The in-network and out-of-network deductibles are tracked separately, so meeting one doesn't apply to the other. You'll likely still owe the full amount for out-of-network care until that deductible is met.

Submitting an out-of-network claim through Suprabill only takes a few minutes. Once submitted, your claim is sent to your insurance company within hours. Most insurers process claims within 1 to 3 weeks, but some plans may take up to 4 to 6 weeks depending on their contract terms. If you haven't received an update after 6 weeks, it's a good idea to check your insurance portal or contact your insurer directly.

Once your insurance company reviews the claim, they'll issue an Explanation of Benefits. This is not a bill. It shows:

• What was covered
• What they paid (if anything)
• What they applied to your deductible
• What you may still owe

If your deductible has been met, the insurance company may mail you a check along with the Explanation of Benefits. Some plans also allow for direct deposit. If not, you may simply see the adjustment on your deductible balance.

Yes. Most insurance companies let you track claim status and view your Explanation of Benefits through their online member portal. This is often the fastest way to monitor your claim. Keep in mind it may take a few days for the claim to appear. Suprabill will also update you once the insurance company has accepted the claim for processing. You'll see real-time updates right in your dashboard.

At the moment, Suprabill doesn't track payments or deductibles, since most insurers send Explanation of Benefits (EOBs) directly to the member. We recommend checking your insurance portal to see what's been paid. We're planning to add tools in the future to help you track reimbursements right within Suprabill.

Suprabill lets you correct most errors before submission. Once a claim is submitted, it can't be withdrawn. We're working on tools to help you amend submitted claims in the future. In the meantime, you can resubmit the corrected claim and reach out to us for a coupon code to cover the new submission.

Suprabill is primarily designed for medical claims, including out-of-network therapy, psychiatry, nutrition, and other health-related services.

Some dental and vision procedures may be eligible if they are billed under your medical insurance such as oral surgeries or eye care related to a diagnosed medical condition.

However, we cannot process routine dental or vision services like:

• Annual eye exams
• Glasses or contact lenses
• Dental cleanings or fillings

These services are usually billed under separate dental or vision insurance plans and we don't support these plans at this time.

Please send us an email at [email protected] from the email linked to your account. We will confirm your identity and delete your information.

We take your privacy and data security seriously. All information you provide is encrypted and stored securely. While HIPAA does not apply to Suprabill because we are not a healthcare provider or insurance company, we follow strict privacy and security practices. If we ever become a business associate of a HIPAA-covered entity, we will fully comply with HIPAA requirements. In the meantime, your data is protected under the terms outlined in our Privacy Policy.

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