A free tool

Get back what your insurance owes you

If you paid cash to see a provider outside your insurance network, your plan may owe you part of it. Insurers want that request in a particular shape, with the right codes and provider details, and a letter that misses something gets returned. Copy what is on your superbill into the fields below and this writes the letter for you.

Nothing here leaves your browser. Your name, diagnosis codes and insurance details are never sent to us, never stored and never logged; the letter is assembled on your own device. The one exception is the diagnosis-code search, which sends the words you type (for example “low back pain”) to the U.S. National Library of Medicine's public code list, and nothing else.

Your provider

Copy this from the superbill or itemised receipt they gave you. If you do not have one, ask the front desk for a superbill: it is a standard request and they will know what you mean.

Practice name *

Provider name

Credentials

NPI

Tax ID or EIN

Provider address

Provider phone

Provider type

You

Your full name *

Date of birth

Street address

City

State

ZIP

Phone

Your insurance

This is for out-of-network health plan claims. A car accident or a work injury is handled differently, through that carrier's injury claim process rather than a letter like this one.

Insurance company *

Policy or member ID *

Group number

Subscriber name

Relationship to subscriber

What you paid for

Enter the codes exactly as your provider wrote them. We do not guess these: their coding is what the insurer matches against, and a code you invent is a denied claim. If one looks wrong, ask their billing staff to correct the superbill first.

Total charges

$0.00

Amount you paid ($)

Needs your name, the practice name, your insurer, your member ID and at least one code.

Your letter

Read it before you send it, and enclose the itemised superbill and proof that you paid. This does not guarantee reimbursement: that depends on your plan's out-of-network benefits. Ring the number on your insurance card to confirm your coverage and where to send it.

What this is. A document formatter. It arranges information you provide into the letter insurers expect. It does not read your policy, choose your codes, contact your insurer, negotiate or file anything for you; you send the letter yourself. It is not legal, medical or insurance advice.

Diagnosis-code descriptions come from the U.S. National Library of Medicine's public ICD-10-CM list, so they stay current as codes are retired and replaced.