Out of Network Insurance

Things to Know

• If the provider you would like to see is considered Out of Network, you may be able to have your services (based on your specific policy) fully or partially reimbursed.

• Out of Network often does not mean you cannot see your provider. It just means you have to do a little more research and handle the reimbursement process yourself.

• Be clear and specific when asking questions of your insurance provider.

Important Disclaimer:

Reimbursement for out-of-network care is solely determined by your insurance provider and based on your specific policy. AceMed Seattle cannot guarantee reimbursement or the amount of reimbursement you may receive. We strongly encourage you to contact your insurance provider directly to verify coverage and reimbursement details to ensure accurate and complete information.

Questions to Ask Your Insurance Provider

When contacting your insurance provider, consider asking the following questions:

Coverage Details

• Does my plan cover services provided by the specific provider?

• Does my plan cover the following services:

  • Naturopathic care?

  • Massage therapy?

  • Osteopathic manipulative treatment?

  • Nutrition counseling?

  • Mental health counseling?

Out-of-Network Reimbursement

• Are out-of-network providers eligible for reimbursement?

• If so, what are the requirements for reimbursement?

• Is a referral from my primary care provider required?

• What is the number of visits covered per calendar year?

• What percentage of the service cost will be reimbursed?

Steps to Take Once You Confirm Your Benefits

1. Choose the provider you would like to see.

2. Collect all necessary information from your insurance provider about how to file for reimbursement.

3. Submit multiple Superbills/Receipts in one mailing, if applicable (including those for multiple family members).

How to Pay for Out-of-Network Care

• AceMed Seattle requires full payment at the time of service.

• Accepted payment methods include:

  • HSA cards

  • Credit/Debit cards

  • Cash

Documentation Required for Reimbursement

If you qualify for reimbursement, clarify with your insurance provider what documentation they need. Most insurance companies require the following:

• A Superbill (an itemized receipt that includes diagnosis codes, service details, and provider information).

• A receipt of payment for the services rendered.

How to Obtain a Superbill:

• Ask your provider directly or request one from our reception team. We are happy to assist you in obtaining this documentation upon request.

How to Submit Your Superbill:

1. Find the claims submission address on the back of your insurance card.

2. Mail your Superbill and receipt to the appropriate address.

Follow-Up

• If reimbursement is not received within one month, contact your insurance provider to check the status of your claim.

• It is essential to follow up, as insurance companies will not contact you about delays or missing information.