Skip to main content

Filing out of network with SP?

Answered

Comments

11 comments

  • Julie P. Sanniota

    I only accept Bcbs but I file out of network for several other insurance companies. It is easy to file. I set my rate, the client pays the difference between their out of network payment and the established rate. At least the person gets to use some of their insurance benefit. People appreciate the effort I think!

    Comment actions Permalink
  • Gillian

    Hi Lucy, please refer to this Help Center guide for more information on out-of-network claim filing: https://support.simplepractice.com/hc/en-us/articles/209755893-Out-of-network-electronic-claim-filing

    Comment actions Permalink
  • Lucy Dunning

    Hi! I have followed the instructions but do I need to actually submit anything? 

    Comment actions Permalink
  • Gillian

    Hi Lucy, in order to file out-of-network (courtesy bill) for a client, you'll need to submit the claim you created to their payer using the Submit button on the claim, or you'll need to provide a Superbill to the client for them to submit themselves. 

    Comment actions Permalink
  • Sanjeev Singhal MD

    Hello I have recently started solo practice and trying to figure out how to check out of network benefit for patients. Is there anyway before hand to check if they have out of network benefit and how much will they cover?

    Comment actions Permalink
  • Gillian

    Hi Sanjeev, the best way to check out-of-network benefits for patients is to give their insurance payer a call. We have a great webinar on checking benefits here: https://www.simplepractice.com/blog/verification-of-benefits-ask-a-biller-video-3/

    Comment actions Permalink
  • Natalia Buchanan

    Gillian, I don't see a submit button on the invoice.  Or is a claim different?  I'm completely private pay but exploring the idea of courtesy billing.

    Comment actions Permalink
  • Gillian

    Hi Natalia, a claim is a different document from an invoice. To create a claim, visit the client's Billing tab, then click +Create > CMS-1500. That will generate a CMS-1500, or claim, which you can then submit to the client's insurance payer for out-of-network courtesy billing. 

    Comment actions Permalink
  • Lena Sheffield

    I also submit billing for out of network claims. I use various methods. One company works best sending paper claims, another I use Availity (free). I haven't tried SP for out of network billing, 

    the only insurance I am in-network with requires I go to their website so it's easy enough, I  then manually enter the insurance payment in SP.  After several trials I think I've figured out all the places on SP to change the date on so I can have a clean record.  Regardless of payment date I enter the payment received on the date of service. 

    Still not used to all the entries in the billing section of SP.  Right now I see 4,  the service date, the invoice date the payment date and invoice payment date.  

    Comment actions Permalink
  • Kim Hertz

    If I courtesy bill for a client and I prefer the insurance check to go for me, with the client then paying the remainder, what is the best way to keep track of insurance payments coming in but also the client balance. Should this client be set to self-pay or insurance?

    Comment actions Permalink
  • Ruth

    Hi Kim - If you're filing courtesy claims and still want the insurance payments to be made out to you, then make the client an Insurance Pay client and mark all these billed sessions insurance pay. You'll want to then add Insurance Payments manually, or enroll in Payment Reports through SimplePractice. 

    Comment actions Permalink

Please sign in to leave a comment.