What’s a Superbill and How Can It Help You Get Affordable Therapy?
What Is a Superbill?
A superbill is basically a detailed, itemized “receipt” that your healthcare provider (such as a therapist or psychologist) can give you after a session.
A superbill includes specific clinical administrative codes (called CPT codes) that health insurance companies require in order to process out-of-network claims. It also will include a psychological diagnosis
Superbills are used when a therapist is out-of-network (OON) with your insurance plan. That means that they don’t have a direct contract with your specific insurance company. OON therapists can’t directly bill your insurance company. Instead, you can submit a superbill to your insurance provider and request some reimbursement.
How Does the Superbill Reimbursement Process Work?
If your insurance plan includes Out-of-Network Benefits (common with PPO plans), here is a sample of that process:
Pay for Your Session: You pay your therapist's standard fee up front at the time of your appointment.
Receive Your Superbill: Your therapist will issue your superbill (usually monthly) via a secure client portal or email. We use SimplePractice at Evergrow.
Submit to Your Insurance: You submit the superbill along with a basic OON claim form directly to your insurance company (via their online portal, mail, or sometimes claim-submission apps like Reimbursify).
Processing & Deductibles:
If you have not met your out-of-network annual deductible, the cost of the session will be applied toward meeting it.
Once your deductible is met, your insurance company will send you a reimbursement check (or direct deposit) for a percentage of the session cost (often 50% to 80%).
Questions to Ask Your Insurance Before Starting OON Therapy
Before relying on superbill reimbursements, you may want to to call the member services number on the back of your insurance card and ask these questions:
"Does my plan include out-of-network mental health benefits?"
"What is my out-of-network deductible, and have I met any of it yet?"
"What is the reimbursement rate (coinsurance) for CPT code 90837 once my deductible is met?"
"Is a specific diagnosis code (ICD-10) required on my superbill to qualify for reimbursement?"
"How do I submit out-of-network claim forms and superbills?"
Key Takeaway
A superbill is great for unlocking out-of-network health benefits, especially when in-network providers can be hard to come by. While paying up front requires an initial investment, utilizing superbills can make seeing the right specialized therapist much more affordable in the long run.
