One of the most common questions we get from patients with PPO insurance plans is: "Can I still use my insurance at Meadow?" The short answer is: not in the traditional sense — but in many cases, you can still get reimbursed for a significant portion of your costs. Here's how it works.
How Meadow's Billing Model Works
Meadow Primary Care is a Direct Primary Care practice. We do not bill insurance companies for visits — not because we can't, but because removing the insurance billing middleman is precisely what allows us to offer same-day access, 30+ minute visits, and a flat predictable monthly fee. When insurance enters the equation, so does coding, prior authorizations, claim denials, and everything else that slows down and complicates care.
For patients without insurance, this is entirely straightforward. For patients with PPO insurance, there's a useful tool: the superbill.
What Is a Superbill?
A superbill is a detailed receipt that includes all the information your insurance company needs to process a reimbursement claim: diagnosis codes (ICD-10), procedure codes (CPT), your provider's NPI number, date of service, and the amount paid. It's essentially everything on a standard insurance claim — just formatted for you to submit directly rather than sent by the provider.
When you pay for a visit at Meadow using your membership, we can provide you with a superbill that you submit to your PPO insurer for out-of-network reimbursement.
Will My PPO Insurance Reimburse Me?
It depends on your specific plan. Most PPO plans have out-of-network benefits that cover a percentage of the allowed amount for a covered service, after your out-of-network deductible is met. Common scenarios:
- Strong PPO plan: May reimburse 60–80% of the allowed amount after out-of-network deductible
- High-deductible PPO: Visits apply toward your deductible; once met, reimbursement kicks in
- PPO with limited OON benefits: May reimburse less, or only for specific service types
The key thing to check: does your PPO plan have out-of-network benefits, and if so, what is the out-of-network deductible and coinsurance rate? Your plan's Summary of Benefits document will have this information, or you can call the member services number on your insurance card.
HMO Plans Are Different
HMO plans typically do not have out-of-network benefits, which means superbill reimbursement generally does not apply. If you have an HMO, you would pay Meadow's membership fee entirely out of pocket — which many patients find worthwhile given the access and quality of care. Check your plan type if you're unsure.
HSA and FSA Accounts
If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), your Meadow membership fees and any visit-related expenses may be eligible for reimbursement using those pre-tax dollars. This effectively reduces your out-of-pocket cost. Check with your HSA/FSA plan administrator to confirm eligibility — most DPC memberships qualify under IRS guidance, though rules vary.
How to Get a Superbill from Meadow
Simply request a superbill when you check in or at the end of your appointment. We'll provide a complete document with all necessary codes and provider information. You then submit it directly to your insurance company — most insurers have an online portal or a paper submission process for out-of-network claims.
If you have questions about how your specific plan might work with Meadow, we're happy to talk it through before you sign up. Text or call (941) 340-1649.
Serving Manatee County
- Lakewood Ranch: 9030 58th Dr E, Suite 102, Bradenton, FL 34202
- Monday–Friday · 8:30 AM – 4:30 PM · Telehealth statewide across Florida
Frequently Asked Questions
Meadow Primary Care does not bill insurance directly. However, if you have a PPO plan with out-of-network benefits, we can provide a superbill — a detailed receipt you submit to your insurer for reimbursement. The amount you get back depends on your specific plan's out-of-network coverage.
A superbill is a detailed medical receipt containing diagnosis codes, procedure codes, your provider's NPI, and service date — everything your insurance needs to process a reimbursement. You submit it directly to your insurer through their member portal or by mail. Meadow provides superbills upon request.
In most cases, yes. DPC membership fees are generally eligible for HSA and FSA reimbursement under IRS guidance. Check with your HSA or FSA plan administrator to confirm eligibility under your specific account rules.
HMO plans typically do not have out-of-network benefits, so superbill reimbursement usually does not apply. Meadow's membership fee would be paid out of pocket. Many HMO patients still find the membership worthwhile given same-day access, longer visits, and direct provider access.
Reimbursement varies by plan. PPOs typically cover 60–80% of the allowed amount for out-of-network services after the out-of-network deductible is met. Check your Summary of Benefits for your specific out-of-network deductible and coinsurance rate.
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