What Is a Therapy Superbill? A Guide to Out-of-Network Benefits.
Finding a therapist who feels like a good fit, both clinically and personally, can be challenging enough. Figuring out the financial side of therapy and whether your insurance will help cover the cost can add another layer of confusion.
The good news is that working with a private-pay therapist doesn't necessarily mean you'll have to cover the full cost yourself. Depending on your insurance plan, you may have out-of-network benefits that allow you to receive partial reimbursement for therapy.
What is a Superbill?
A superbill is a document provided by your mental health provider that summarizes the services you received. It includes information such as provider details, dates of service, fees, and billing and diagnosis codes. You can submit this document to your health insurance company to request potential reimbursement.
How Much Will Insurance Reimburse?
Reimbursement depends on your insurance plan, the allowed amount your insurer recognizes for the service, and your plan's reimbursement rate. Some plans reimburse a percentage of the allowed amount after the out-of-network deductible has been met, although reimbursement rates and coverage vary considerably by plan. Some plans, including many HMO plans, may not cover out-of-network services unless an exception applies. Contact your insurance company to verify your specific benefits.
Example
Therapist’s fee (paid upfront):
$150
Insurance company’s allowed amount:
$125
Your plan’s reimbursement rate:
70%
What insurance pays you:
$87.50 (70% of $125)
Your Out-Of-Pocket Cost After Reimbursement :
$62.50 ($150 – $87.50)
This hypothetical example assumes the deductible has been met and the insurer approves the claim. Actual reimbursement may differ.
How Does Reimbursement Work?
Step 1: Check your insurance benefits - Contact your insurance company to find out whether your plan covers out-of-network outpatient mental health services.
Step 2: Ask about your costs - Ask about your out-of-network deductible, reimbursement rate for a 50-minute virtual therapy session (CPT code 90834 with modifier 95), any session limits, and whether prior authorization is required.
Step 3: Pay for your therapy sessions - With a private-pay therapist, you generally pay the session fee to the therapist at the time of service. HSA and FSA cards are accepted for eligible expenses, subject to applicable plan rules.
Step 4: Obtain your superbill - Your therapist will provide the document. I provide superbills at the end of each month.
Step 5: Submit your claim:
Option 1: Submit the Claim Yourself-
You can usually submit an out-of-network claim through your insurance company's online member portal or mobile app, if this option is available. Look for a section such as “Submit a Claim” or “File an Out-of-Network Claim,” and follow the instructions to upload your superbill. Your insurer can tell you how to submit a claim if you need help.
There is generally no additional fee to submit a claim directly through your insurer.
Option 2: The Convenience Route (Third-Party Mobile App)
Services like Reimbursify can help simplify the process of submitting out-of-network insurance claims. You can upload a photo or PDF of your superbill through the app, which submits the claim to your insurance company and allows you to track its status.
Reimbursify offers the first claim submission for free. Subsequent claims cost $3.99. Pricing and fees may change, so check the Reimbursify website for current information.
Note: I am not affiliated with or sponsored by Reimbursify. This is an optional resource you may wish to explore.
Questions to Ask Your Insurance Provider
Before beginning therapy, consider asking:
Do I have out-of-network benefits for outpatient mental health therapy?
Have I met my out-of-network deductible?
What percentage or amount will my plan reimburse?
Is there a limit on the number of covered sessions?
Do I need prior authorization or a referral?
What information and documentation do I need to submit a claim?
How long does reimbursement typically take?
What Should I Know Before Using a Superbill?
A superbill does not guarantee reimbursement
Not all insurance providers have out-of-network mental health benefits
If your plan requires you to meet an out-of-network deductible before reimbursement begins, eligible claims may be applied toward that deductible until it is met.
Reimbursement is based on the allowed amount: Your insurance company may reimburse a percentage of the amount it recognizes for the service, rather than a percentage of your therapist’s full fee.
Insurance claims for mental health services generally require a diagnosis, and submitting a claim means sharing that information with your insurer.
Reimbursement, if approved, is determined by your insurance plan, not your therapist.
Is Private Pay Right for Me?
Private-pay therapy may be a good fit if you prefer to pay directly for your sessions rather than use insurance. Because you are paying privately rather than using insurance, your treatment is not subject to your insurer’s coverage requirements, which may include a mental health diagnosis, session limits, and documentation of medical necessity.
Cost is an important consideration, too. Depending on your insurance plan, you may have out-of-network benefits that allow you to submit a superbill for possible reimbursement. HSA and FSA funds may also be used for eligible mental health expenses.
Questions about Getting Started?
If you're considering therapy, I'm happy to talk with you. You can schedule a free 20-minute consultation to discuss what brings you to therapy, ask questions, and see if working together feels like a good fit.
Disclaimer: This article is for informational purposes only and is not intended as financial, insurance, or legal advice. Insurance coverage and out-of-network benefits vary by plan. Providing a superbill does not guarantee reimbursement, as all coverage and reimbursement decisions are made by your insurance company. Please contact your insurer directly to verify your benefits, coverage, and any requirements before beginning therapy.