At New Horizon Infusion Clinics, we strive to offer our patients as many financial options as possible. Since the use of Ketamine for the treatment of mental health conditions and chronic pain is still considered “off label” use, many insurance carriers will not cover the service, and those that do often require some extra steps.

Below are a few tips to assist in the submission of a claim to your insurance.

What questions should I ask my insurance before starting services with New Horizon Infusion Clinics….

Call the number on the back of your health insurance card and ask for “member services. Be sure to ask these questions to verify out-of- network coverage:

  • Do I have out-of-network coverage for ketamine infusion services?
  • What is my yearly deductible? Has it been met or how much more until my deductible is met?
  • How much does my insurance plan reimburse for an out-of- network provider for CPT codes 99213, 96365 and 96366?
    • 99213 – Office Visit Established 20-29 minutes
    • 96365 – Initial IV infusion (up to 1 hour)
    • 96366 – Additional IV infusion (each additional hour)
  • What is my co-payment (if applicable)?
  • Do I need prior authorization?
  • Do I need approval from my primary care provider?
  • What is the home and mailing address on my file? (important to ensure checks are issued to the correct address)
  • How do I submit a super bill? Is there an online portal or do I have to mail or fax a copy?
  • What is the time limit to submit a super bill?

How do I submit my super bill?

Insurances typically have a time limit to turn in your super bill of 60 days or more, some up to 180 days. This can fall under “timely filing”. To submit your super bill, contact your insurance company and ask for “member services” or check their website for instructions. There are usually 3 options for turning in a super bill: mail, fax, or through an online portal.

  1. Mail – you can ask your insurance for an address to mail the super Make sure you allow time for delivery to stay within your limit for timely filing.
  2. Fax – if you would like to keep your protected health information private, we suggest not faxing from a public fax machine (such as at the library) or a work fax machine. The receipt that shows your fax was sent will include this private health information.
  3. Online portal – most insurance providers will have an online portal through which you can upload your super bill. It is the most secure option to send your super bill as the website will request a login or password. It is also faster than mail or fax. Be sure to ask your insurance about this option.

What can you expect after you submit a super bill?

Insurance companies typically have a time limit in which you can submit a super bill. If you submit your super bill after this time limit, you risk losing any potential reimbursement.

It can typically take your health insurance 2-4 weeks to process your super bill. They will either pay the full amount of services minus your copay, or they will put this amount towards your deductible. If your super bill is denied, call your insurance and request information about the denial.