How To Be Reimbursed for Therapy via a Superbill
Key Points:
A Superbill is an invoice that lists the therapy services a person has received, which they will file with their insurance for reimbursement
A Superbill can only be used for reimbursement if you have out-of-network benefits with your insurance plan
It is the client’s responsibility to coordinate with their insurance company to get reimbursed using a Superbill
Therapy costs can add up, especially for clients who pay privately for therapy services. We hope this post can enlighten you on Superbills, how they work, and how you can use them to save some money on therapy costs. In this post, I will use "therapist” and “provider” interchangeably.
Using Insurance vs. Private Pay (or “paying out-of-pocket”)
There are a few ways to cover the costs of therapy, and the two main ways are insurance and private pay. If you are using insurance, it is the provider’s responsibility to file claims with your insurance company for reimbursement.
However, if your provider is not paneled with your particular insurance company or any insurance companies, nor accepts your specific type of plan, you may choose to pay “out-of-pocket” (private pay) for services. Privately paid therapy might seem like your benefits go unused, but this is not always true. And here is where a Superbill might come in handy!
So—what is a Superbill and how do I know if I can use it?
A Superbill is an invoice that lists the therapy services a person has received, which can be presented to your insurance company for reimbursement. While anybody can requests invoices for services received, Superbills are intended to be used by clients who are trying to get reimbursed for therapy using their out-of-network benefits from their insurance plan.
If you (1) do not have insurance or (2) have insurance but don’t have out-of-network benefits, getting reimbursed with a Superbill is not an option for you.
What information goes on a Superbill?
Identifying information about you - name, address, and phone number
Identifying information about your provider’s practice - name, address, phone number
Provider identification - national provider ID numbers and license type and number of your therapist
ICD codes — codes that help identify specific diagnoses as a diagnosis is required for reimbursement from your insurance company
CPT codes — codes that help identify the type of service provided (60 min. individual session, group therapy, etc.)
How do I know if I have out-of-network benefits?
Call your insurance company directly to find out more about your out-of-network benefits. Not every insurance plan has them, so it’s good to confirm before you begin therapy. If you’re reading this after starting therapy, it’s never too late to find out if you can get reimbursed! Using the member-specific service line on the back of your insurance card, here are a list of example questions you might consider asking your insurance provider:
Do I have any out-of-network benefits for outpatient mental health services?
What is the deductible I must meet in order to start getting reimbursed for my out-of-network benefits?
What’s the process in order for me to get reimbursed for out-of-network benefits?
How long will it take for me to get reimbursed?
Do I have any co-insurance rates (the % you pay for services) for out-of-network benefits?
Is there a limit to the amount of reimbursement I can receive in a given year of coverage?
Step by Step Guide to Using a Superbill
1.) Call your insurance company to determine your out-of network benefits.
First and foremost, it’s important you learn what type of benefits your insurance plan might have with out-of-network providers. If a therapist is not connected/paneled with your particular insurance company, they are considered “out-of-network.” Call the number on the back of your insurance card to ask about your out-of-network benefits and how you can use them for therapy. Use the questions listed above as guide.
2.) Confirm with your therapist you would like Superbills created for you.
It’s important you communicate with you therapist that you would like Superbills generated as they’re not automatically generated. This will also spark a conversation about any diagnostic criteria you meet as part of your clinical treatment (which should be a conversation that happens regardless of Superbill use). Your therapist will likely give you a printed copy of your Superbill or an electronic version sent over a HIPAA-compliant portal.
3.) Create a plan of action for reimbursement.
Using the information given to you by your insurance in Step 1, determine the best way to send your Superbills to your insurance company to start getting reimbursed. Every insurance company is different. Some might be open to you sending Superbills directly by uploading it online or sending it by fax. Others might ask you to fill out some forms instead. Once you confirm your options, create a plan on ways to submit your Superbills regularly for reimbursement.
4.) Get reimbursed for your therapy services.
Continue to participate in therapy regularly while getting reimbursed for services!
We hope this post has been helpful in providing information and guidance on the use of Superbills. If you have questions or are still unsure, contact us at hello@belongingcounselingtx.com or your provider directly.
