Self-Pay Using your superbill
Out-of-network reimbursement
How to use your superbill
If you’re paying out of pocket because your plan is out-of-network and your plan includes out-of-network benefits, a superbill is how you ask your insurance to pay you back. Here’s exactly what to do, and what to do if your first claim is denied.
Before you submit a superbill
Reimbursement only works if your plan has out-of-network benefits.
Submitting a superbill only results in money back if your insurance plan includes out-of-network (OON) benefits. PPO plans usually do; HMOs, EPOs, Medicaid, and most Marketplace plans don’t. They only cover in-network providers. Check your Summary of Benefits or call the number on your card before going through the steps below.
What is a superbill?
A superbill is an itemized receipt of your visit. It contains everything your insurance carrier needs to process an out-of-network claim: the dates of service, the diagnosis (ICD-10) codes, the procedure (CPT) codes, the charges, our provider information, and our tax ID. You pay us at the time of service; the superbill is what you send to your carrier so they reimburse you directly.
Submitting your claim
Four steps to submit a superbill
Most carriers process out-of-network claims through their member portal. The whole process usually takes 15–20 minutes.
Request your superbill from us
Email billing@bcbreastfeeding.com after your visit and we’ll send it within one to two business days. We provide superbills on request for every self-pay or out-of-network visit, no charge.
Find your carrier’s out-of-network claim form
Log in to your insurance carrier’s member portal (or the app) and search for “out-of-network claim” or “member-submitted claim.” Most carriers have an online upload form; some still require a PDF claim form mailed in.
Submit the claim form with your superbill attached
Fill out the claim form with your member info, attach the superbill PDF, and submit. If the form asks for a “diagnosis code,” “procedure code,” “place of service,” or “billed amount,” those values are all on the superbill we sent you.
Watch for the EOB and reimbursement check
Within two to six weeks, your carrier will send an Explanation of Benefits (EOB) showing how the claim was processed. If approved, reimbursement is paid directly to you by check or direct deposit, not to us.
If your claim is denied
What to try next
First-pass denials are common, and often reversible. Here are the tactics that work most often. Each one is worth doing in order.
Read the EOB carefully
The EOB lists a denial reason code and a short explanation. Common reasons: “service not covered,” “no out-of-network benefit,” “missing referral,” “exceeds plan limit.” The reason determines which tactic comes next.
Call member services with the EOB in hand
Ask the rep to explain the denial in plain language and confirm which CPT code was denied and why. Sometimes a single keyed-wrong digit on the claim is the entire problem and can be reprocessed on the call. Always note the rep’s name, the date, and a call reference number.
Cite the ACA preventive-services rule
Under the Affordable Care Act, most plans must cover comprehensive lactation support and counseling at no cost to the member during pregnancy and the postpartum period. If your denial says “not covered” for a routine lactation visit, ask the rep specifically about the plan’s ACA preventive lactation benefit. Many denials are reversed at this step.
File a formal written appeal
Every EOB lists an appeals deadline (often 180 days). Submit a short written appeal stating the visit was a covered preventive lactation benefit, attaching the superbill, the EOB, and the call reference numbers from the rep you spoke with. Carriers are required to respond within a defined window.
Request a letter of medical necessity
If the denial cites medical necessity (rare for lactation visits), email us. We can provide a letter from your IBCLC documenting why the visit was clinically indicated. Attach it to your appeal.
Request your complete claim file
ProPublica’s free Claim File tool generates a request letter you can send to your insurer asking for the complete file they keep on your case, including internal notes, medical reviewer comments, and which policy provisions they applied. Especially useful if you suspect a denial was made in error or are preparing to escalate to your state insurance commissioner.
This page is general guidance and not insurance or legal advice. Coverage rules, deadlines, and appeals processes vary by carrier and plan; always confirm specifics with your insurance carrier directly.
Need a superbill from a recent visit?
Email our billing team and we’ll send your itemized superbill within one to two business days, no charge.
Email billing@bcbreastfeeding.com