Understanding a Superbill: What It Is and How to Use It
Joint Action Physical Therapy is committed to providing high-quality, personalized care. As a cash-based practice, we do not bill insurance directly. However, we provide detailed superbills to help you seek potential reimbursement for out-of-network services from your insurance provider. Below is everything you need to know about superbills and how to use them in the context of our services.
What Is a Superbill?
A superbill is a detailed, itemized receipt that outlines the healthcare services you received. It serves as a record of your care and provides all the necessary information your insurance company needs to process a claim for out-of-network reimbursement. Unlike a regular receipt, a superbill includes specific medical details, such as:
- Provider information: Name, address, and contact details of [Your Business Name]
- Patient information: Your name and identifying details
- Date(s) of service
- Description of services provided
- CPT codes: Standardized codes for the procedures or treatments performed
- ICD-10 codes: Diagnostic codes that explain the reason for the services
- Total cost of each service
How Does a Superbill Work?
- Receive the Superbill: After each session, we will provide you with a superbill that documents the services you received.
- Submit to Your Insurance Provider: You can submit the superbill to your insurance company for review. Many insurance plans offer out-of-network benefits, which may cover a portion of the costs.
- Processing and Reimbursement: Your insurance company will review the superbill, determine your eligibility for reimbursement, and issue payment directly to you, if applicable. The amount reimbursed depends on your specific insurance plan and benefits.
How to Use a Superbill with Your Insurance
Many times, the process for submitting the superbill to your insurance will be clear and readily outlined in your policy's website login along with a form to submit out-of-network claims. If you are unable to find it, below is a detailed breakdown of how to proceed.
- Contact Your Insurance Provider: Before submitting a superbill, call your insurance company and/or check your plan summary/documentation to understand your out-of-network benefits. The backside of your insurance card will have the phone number to call. Ask about or look for:
- Your out-of-network deductible and how much has been met
- The percentage of costs covered for out-of-network services
- Any requirements, such as a referral or pre-authorization
- Prepare Your Submission: Follow your insurance company's guidelines for submitting out-of-network claims. This may involve filling out a claim form and attaching your superbill. You will often need to include your proof of completed payment. We ensure you have the documentation and details you need.
- Submit the Claim: Send the completed claim form and superbill to your insurance company by mail, email, or through their online portal, as directed.
- Follow Up: Keep a copy of your submission and follow up with your insurance company if you do not hear back within their specified timeframe.
Insurance Provider-Specific Guidance
When submitting out-of-network claims to your insurance provider, it’s important to note that procedures can vary based on your specific plan, especially if it’s established outside of New Jersey, such as employer-provided insurance from an out-of-state employer. Always verify the process with your insurance company before submission.
Below is starting guidance for submitting out-of-network claims to some of the most common health insurance providers in New Jersey.
Horizon Blue Cross Blue Shield of New Jersey
- Online Submission: Log in to your member account on the Horizon website or app. Navigate to the ‘Claims’ section and select ‘Submit a Claim.’
- Mail Submission: If you prefer mailing your claim, download the appropriate claim form from Horizon’s website, complete it, and send it along with your superbill to the address provided on the form.
- Member Services Phone Number: 1-800-355-2583
AmeriHealth New Jersey
- PDF Claim Form: https://www.amerihealth.com/pdfs/explore-plans/individuals/nj-ppoclaim.pdf
- Submission: Complete the form and mail it with your superbill to the address specified on the form.
- Member Services Phone Number: 1-888-968-7241
Aetna
- Member Portal: Access your Aetna member account online: https://www.aetna.com/ (must start at home page, cannot link directly to login screen)
- Claim Submission: Follow the instructions for submitting an out-of-network claim, which may involve uploading your superbill through the portal or mailing it to a designated address.
- Member Services Phone Number: 1-800-872-3862
UnitedHealthcare
- Online Submission: Log in to your UnitedHealthcare member account: https://member.uhc.com/myuhc?locale=en-US
- Claim Process: Navigate to:
- Claims & Accounts in top bar
- Medical & Mental Health, click "Start a Claim"
- Click "Start new claim form"
- Member Services Phone Number: 1-866-414-1959
Oscar Health
- Request prior authorization: https://www.hioscar.com/form/oon-request-form
- Member Services Phone Number: 1-855-672-2755
Humana
- Access Claims Form: https://www.humana.com/member/documents-and-forms (Health Benefit Claim Form)
- Member Services Phone Number: 1-800-448-6262
Cigna
- Access Claims Form: Log into your Cigna online account and choose the "claims" section
- Member Services Phone Number: 1-800-244-6224
Horizon NJ Health
- Online or in-app: When you submit out-of-network medical health claims through your account on the website or the Horizon Blue app, you don’t need to include a claim form. To submit a claim online, log in to your online account and simply select Claims, then Submit a Claim. Use this link if you're already logged in.
By Mail: If you prefer to submit claims by mail, include the appropriate claim form below and mail it, and the required information listed on the form, to the address on the form:
- Merck members: Merck Health Insurance Claim Form
- Organon members: Organon Health Insurance Claim Form
- State Health Benefit Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) members: SHBP/SEHBP Medical Plan Claim Form
- All other members: Horizon Health Insurance Claim Form
- Further information: https://www.horizonblue.com/helpcenter/topic-submitting-claims#:~:text=Where%20can%20I%20find%20and,Horizon%20Health%20Insurance%20Claim%20Form
WellCare
- Reach out to WellCare’s member services to receive guidance on submitting out-of-network claims, as procedures can vary widely by plan.
- Member Services Phone Number: 1-866-765-4385
Our Commitment to You
Our decision to remain out-of-network is rooted in our commitment to provide exceptional care and to prioritize your needs above all else. We understand that this model may not work for everyone, but we believe it’s the best way to ensure that you receive the focused, effective, and high-quality care you deserve.
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