How To Submit A Superbill

A superbill is a detailed receipt that includes information about the healthcare services you received. You may submit it to your insurance company to request reimbursement for out-of-network services.

Submitting a superbill does not guarantee that your insurance company will reimburse you. Coverage and reimbursement amounts depend on your individual insurance plan, deductible, out-of-network benefits, and the services provided.

Before Your Appointment

We recommend contacting your insurance company before your visit to ask whether your plan includes out-of-network benefits.

You may want to ask:

• Does my plan include out-of-network benefits for this type of service?
• Do I have an out-of-network deductible?
• How much of my deductible has been met?
• What percentage of the allowed amount will my plan reimburse?
• Is prior authorization or a referral required?
• Are there any exclusions for the services I am receiving?
• What information is required when submitting a superbill?
• Is there a deadline for submitting an out-of-network claim?

You may also ask whether your insurance company can estimate reimbursement based on the procedure codes provided by our office. Please keep in mind that an estimate is not a guarantee of payment.

Common codes we utilize: 99205 or 99204 for a new patient visit, 99215, 99214, 99213, 99212 for a follow-up visit.

What Is Included on a Superbill?

Your superbill may include:

• Your name and date of birth
• The date of service
• The provider’s name and credentials
• The provider’s National Provider Identifier, or NPI
• The practice name, address, and tax identification information
• Diagnosis codes
• Procedure or service codes
• The amount charged
• The amount you paid

Please review the superbill to make sure your personal information is correct before submitting it.

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1. Obtain an Out-of-Network Claim Form

Visit your insurance company’s website or member portal and look for a form labeled:

• Member claim form
• Medical claim form
• Out-of-network claim form
• Request for reimbursement

You may also call the member services number listed on the back of your insurance card and ask how to submit an out-of-network claim.

2. Complete the Claim Form

Fill out all required sections of the form. Information commonly requested includes:

• Your member identification number
• Your group number
• Patient information
• Provider information
• The reason for the visit
• Whether the services were related to an accident or injury
• Whether another insurance plan may be responsible for payment

Sign and date the form where required.

3. Attach Your Superbill and Proof of Payment

Include a copy of the superbill with your completed claim form.

Your insurance company may also request proof that you paid for the service. Acceptable documentation may include:

• A receipt
• A credit card receipt
• A payment confirmation
• A statement showing a zero balance

Do not send original documents unless your insurance company specifically requires them. Keep copies of everything you submit.

Let a member of our team know if you need any proof of payment.

4. Submit the Claim

Depending on your insurance company, you may be able to submit the claim:

• Through your online member portal
• Through the insurance company’s mobile application
• By email or secure upload
• By fax
• By mail

Follow the instructions provided by your insurance company. If submitting by mail, consider using a service that provides tracking or delivery confirmation. Keep track of the dates you submitted everything so you can reference them for any problems/delays.

5. Save Your Confirmation Information

Keep a copy of:

• The completed claim form
• The superbill
• Proof of payment
• Any confirmation number
• The submission date
• Any correspondence from your insurance company

This information may be helpful if you need to follow up or appeal a denied claim.

What Happens After Submission?

Processing times vary by insurance company. You may be able to monitor the claim through your online member portal.

Your insurance company may:

• Reimburse you for a portion of the cost
• Apply the allowed amount toward your out-of-network deductible
• Request additional information
• Deny the claim
• Determine that the service is not covered under your plan

Reimbursement is typically based on the insurance company’s allowed amount, which may be lower than the amount you paid.

For example, if you paid $200 but your insurance company’s allowed amount is $120, your deductible and coinsurance may be calculated using the $120 allowed amount rather than the full $200 charge.

Following Up on Your Claim

If you have not received an update within the processing period provided by your insurance company, contact member services.

Have the following information available:

• Your name
• Your member identification number
• The date of service
• The provider’s name
• The amount of the claim
• The date the claim was submitted
• Your confirmation or tracking number

Ask whether the claim was received, whether additional information is needed, and when you should expect a decision.

If Your Claim Is Denied

A denied claim does not always mean that you have no further options.

Review the Explanation of Benefits, or EOB, to determine why the claim was denied. Common reasons include:

• Missing information
• Incorrect member information
• The claim was submitted to the wrong address or department
• The service is excluded from coverage
• Prior authorization was required
• The submission deadline was missed
• The provider or service type is not eligible for out-of-network reimbursement
• The insurance company needs additional documentation

You may be able to correct and resubmit the claim or file an appeal. Contact your insurance company for instructions and deadlines.

Our office may be able to correct information on the superbill or provide documentation related to the services you received. However, we cannot communicate with your insurance company on your behalf, guarantee reimbursement, or change your plan’s coverage requirements.

Important Information

Payment is due to our office according to our financial policy, regardless of whether your insurance company reimburses you.

A superbill is provided as a courtesy to help you request possible out-of-network reimbursement. It is not a claim submitted by our office, a promise of insurance coverage, or a guarantee of payment.

Questions about benefits, claim processing, reimbursement, denials, or appeals should be directed to your insurance company.

Need a Copy of Your Superbill?

To request a superbill, contact:

Menopause New Mexico, Guided by the Clinical Assessment Group
Phone: (505) 600 1735 
Email: contact@menopausenm.com

Please allow approximately 2-3 business days for processing.

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Will my insurance company reimburse the full amount I paid?

Not necessarily. Reimbursement depends on your plan’s out-of-network benefits, deductible, coinsurance, allowed amount, and coverage rules.

Can your office submit the superbill for me?

Our office does not submit out-of-network claims. Patients are responsible for submitting superbills directly to their insurance companies.

When will I receive my superbill?

Superbills are typically available the day of or the day after your appointment.

What if the information on my superbill is incorrect?

Contact our office promptly. We can review and correct inaccurate demographic, payment, provider, diagnosis, or service information when appropriate.

Who should I contact about the status of my reimbursement?

Contact your insurance company’s member services or claims department. Our office does not have access to your insurance company’s claim-processing system.