How Superbills Can Help You Get The Mental Health Services You Need

For many, therapy is an integral part of maintaining personal health and wellness. However, it can get to be very expensive. Often people use their insurance to help off-set the cost of therapy, but find it frustrating when they are limited in the types of services they want, or struggle to find a therapist who accepts their insurance. A new strategy of using “superbills” has become a popular way for individuals to have the flexibility in care they want while also making therapy more financially accessible. This article will explain what a superbill is, and how you can use it to help you get the mental health services you need. 

What is a superbill?

A superbill is a detailed invoice or receipt a therapist gives to their clients who pay out of pocket for their therapy services. Clients can submit the superbill to their insurance provider for potential reimbursement using their out-of-network benefits. The superbill contains more detailed information than a typical receipt, and allows the insurance company to determine if the therapy services are eligible for reimbursement. Superbills usually contain the following information: 

• Therapist’s contact information and credentials

• Clients information 

• Dates of services

• CPT Code (90834 or 90837 detail the length of the appointment)

• The fee for the services provided

How does a superbill differ from traditional insurance? 

The superbill is offered as an alternative to allow clients to receive reimbursement from their insurance companies for services from out-of-network providers. There are several important differences: 

• Who handles the process

• Traditional Insurance: After a therapy appointment, the therapist submits a claim to the insurance company, and the insurance company pays the therapist directly. The client may be responsible for any copay or deductible costs.

• Superbill: The therapist gives the client a superbill after a therapy appointment, and the client is responsible for submitting the superbill for reimbursement. 

• In-Network vs. Out-Of-Network Benefits

• Traditional Insurance: Therapists are considered to be “in-network” when they are paneled (have a contract) with a particular insurance company. The therapist submits a claim to the insurance and receives payment directly. Clients are responsible to pay their copays and deductibles.

• Superbill: Clients can use out-of-network benefits when they receive services from a therapist who is not paneled with a particular insurance company. After submitting a superbill, clients can potentially be reimbursed for a portion of the cost. 

• Reimbursement

• Traditional Insurance: Insurance companies typically pay a negotiated rate to therapists who are in-network providers. Clients must still pay their share through copays and deductibles. 

• Superbill: The client pays the full fee to the therapist at the time of service. After submitting a superbill to the insurance company, clients may receive reimbursement for a portion of the overall cost.

Why do many therapists choose to offer superbills instead of taking insurance?

There are a variety of reasons why a therapist would choose to not accept insurance including: 

• Avoid insurance panel limitations

• Insurance companies often limit the amount of therapists they allow on their panels. Therapists may have to apply multiple times before they can become an in-network provider. 

• It can take an enormous amount of time and effort to fill out the insurance panel applications. Additionally, panels may only be open for a short amount of time every year. 

• Greater control over rates

• An insurance company will set a pre-determined rate for what they will pay for a therapy service. These rates vary drastically from company to company, and do not take into consideration variables such as specialties or individualized care. By using superbills, therapists can maintain a standard of rates for all of their clients. 

•  Administrative burden

• It is an enormous burden to handle insurance authorization, billing, and follow-up for payment. Many therapists do not have the bandwidth or expertise to feel comfortable to handle billing by themselves, and often must employ a professional billing company. Using superbills allows therapists to focus on their field of expertise.  

• Increased flexibility for client care

• Insurance companies may impose limitations on the types of therapy, and amount of sessions they will pay for. Therapists using superbills can offer more individualized therapy for their clients. 

• Concerns with confidentiality

• When a therapist bills an insurance company directly, they must provide detailed information about the client's diagnosis, treatment, and progress. Insurance companies may even request therapists’ notes when determining payment. Some therapists prefer the greater confidentiality that comes in not working with insurance companies.

How do I submit a superbill to my health insurance company?

There are some important steps to follow to make sure you are covered if you plan to use a superbill to receive reimbursement for therapy.

• Check with insurance company FIRST about out-of-network benefits

• Call the Member Service line that is often located on the back of your insurance card.

• Ask about out-of-network benefits, and what documentation is required for reimbursement. 

• Request a superbill from your therapist

• Fill out insurance claim form 

• The claim form can usually be found on the insurance company webpage

• Submit the superbill and claim form

• Track the submission

• Expect reimbursement can take anywhere from 30-90 days

FAQS About Superbills

Here are some frequently asked questions about superbills. 

1. Will I get reimbursed the full amount for my therapy session?

Most insurance companies have set rates to reimburse for out-of-network services which may be lower than what you paid your therapist. You may often be reimbursed 50-80% depending on your insurance plan and whether or not you have met your deductible. 

2. What if my claim is denied?

You will receive an explanation of benefits (EOB) if the insurance company decides to deny your claim which will explain the reason for the denial. Common reasons include missing information, or for services which are not covered. You can appeal the denial by contacting your insurance company and providing any missing information needed. 

3. Can I submit superbills for past sessions?

Every insurance company has a different deadline to submit claims. Be sure to check with your insurance provider for more information about time limits for submitting superbills. 

4. Do all insurance plans accept superbills?

Not all insurance plans accept superbills or even have out-of-network benefits. It’s important to contact your insurance company before starting therapy to better understand your plan’s unique benefits. 

5. Do I need to meet my deductible before getting reimbursed?

Most insurance companies require you to meet your deductible before they will start reimbursing you for your out-of-network services. You will most likely be about to put the cost towards your deductible.