How much money will I get back from each claim?

The amount you receive depends on several factors specific to your insurance plan:

• Whether you have a separate out-of-network (OON) deductible, and how much of it you’ve already met
• Your plan’s coinsurance rate for OON care (often 60–90% of the “allowed amount”)
• Your insurer’s “allowed amount” for the service’s CPT code and your provider’s ZIP code

Here is how a typical reimbursement calculation works once your OON deductible is met:

• Your provider charges: $200
• Your insurer’s “allowed amount” for this service: $140
• Your plan reimburses 70% of the “allowed amount”: $98
• You receive: $98
• Your remaining responsibility: $102

MySuperbills cannot guarantee or predict your reimbursement amount, as that is determined entirely by your insurer. The most reliable way to know your expected reimbursement is to call the member services number on your insurance card and ask for a benefits breakdown using the service’s CPT code and your provider’s ZIP code.