As an Out-of-Network (OON) provider, the following options are available when handling clients who have insurance:
Important: In order for you to be able to file claims electronically as an Out-of-Network clinician within SimplePractice, you may need to register ahead of time as a “non-participating provider” with that payer. This process usually involves filling out a W-9 form, although each payer may have a different requirement. We recommend you reach out to the payer directly to confirm you’re ready to start filing claims even if you’re out-of-network.
Note: If you're not currently a SimplePractice customer and are considering signing up for an account, make sure to take a look at how we streamline insurance billing.
This is the most commonly used option for out-of-network providers. A Superbill is a statement you provide clients so that they can get reimbursed directly from their insurance company.
In this scenario, the client will pay the full appointment fee out-of-pocket. After they pay, you will create a Superbill which details the service, diagnosis, and full cost of the services, to share with the client so that they can submit it to their insurance company directly.
See Creating Superbills for additional information on creating Superbills in SimplePractice.
In this scenario, your client is paying you the full appointment fee but you are going to file the claims on their behalf and the insurance company will reimburse them instead of you. The claims have to be completed in a slightly different manner than normal.
See How do I do courtesy billing? for more detailed information on submitting this type of claim in SimplePractice.
In this scenario, you are filing claims to the insurance payer and the payer will pay you directly because the client has out-of-network benefits. You will file these claims the same way you would file in-network claims. The only difference is that you aren’t bound by a contract with the insurance company so you don’t have to lower your rate.
We typically see that clinicians still get their full fee when doing OON billing. They usually collect whatever partial amount the insurance pays and the remaining amount is collected directly from the client.
Check out our Getting Started with Insurance guide for additional information.
Single case agreement
Out-of-network providers can obtain a single case agreement to provide reimbursable appointments to a specific client. Once obtained, you'll file to the insurance payer as if you are in-network and the appointment would be paid out based on the details of the agreement for that client.