How to Handle Out-of-Network Provider Billing vs. Reimbursement

Good news! Sana accepts medical claims from out-of-network providers without any penalties and we welcome any provider to work with us.

When seeing an out-of-network provider, you can choose between having your provider submit a claim to Sana or paying out-of-pocket and seeking reimbursement based on your provider’s policies and your preference.

Are you on a Sana First Health Plan (SFHP)?

Sana First gives you flexibility in where you receive care, but you must follow the Sana Care referral process for care that requires a referral — even when seeing a non-contracted provider or planning to pay out-of-pocket and request reimbursement.

Start with Sana Care. If outside care is needed, Care Navigation will help identify appropriate provider options based on your medical needs, location, quality, availability, and cost. This may include a Sana direct-contract provider, a HealthSmart provider, or a non-contracted provider who can bill Sana directly.

Once you select an option, Sana will complete the referral process before you receive care.

Paying out-of-pocket or seeing a non-contracted provider does not bypass the Sana First referral requirement. If you receive care that requires a referral without first completing the Sana Care referral process, the claim will be denied and you'll be responsible for 100% of the cost.

Option 1: Provider Submitting a Claim to Sana (Recommended)

Most out-of-network providers are willing to bill Sana directly by submitting a claim to us, so you do not have to pay the full cost of your care upfront.

How it works:

1. Show your Sana ID card to your provider at check-in.
2. Ask them to submit the claim using the electronic Payer ID or the claims billing address printed on your card.
3. The provider submits the claim directly to Sana, and we handle processing on our end.

Tip: If your provider is unfamiliar with Sana, remind them that Sana accepts claims from any licensed provider without penalties. Providers can also verify your benefits prior to service by contacting Sana Support.

Sana First members: If your care requires a referral, make sure the required Sana Care referral is in place before receiving care.

Option 2: Pay Out-of-Pocket & Request Reimbursement

If your provider requires payment at the time of service or refuses to bill insurance directly, you can pay upfront and submit a claim to Sana for reimbursement.

How it works:

1. Pay your provider directly for the visit.
2. Obtain an Itemized Bill (Superbill) showing a $0 balance. The bill must include:
   • Procedure codes (CPT)
   • Diagnosis codes (ICD-10)
   • Provider's NPI (National Provider Identifier)
   • Detailed breakdown of charges
3. Log in to your Sana Member Portal, navigate to the Submit a Claim tab, and upload your documentation.

For detailed instructions and file requirements, review our step-by-step guide on How to Submit a Medical Claim for Reimbursement.

Sana First members: If the care required a referral, a valid Sana Care referral must have been in place before you received the service. Self-paying first and submitting for reimbursement later does not replace the referral requirement.

Quick Comparison: Which Option Should You Choose?