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Finding a good therapist can be tough. And often, the therapist you like most doesn’t accept your insurance. That’s why a growing number of therapy-seekers are going out-of-network.
If you’re seeking therapy with an out-of-network therapist, you’ll want to ask for a superbill. This will help you get reimbursed using your insurance’s out-of-network benefits. And in this blog, we’ll cover the important things you need to know about superbills as a therapy client.
Keep reading to learn what a superbill is, how to use it, and other things you should know.
“A superbill is essentially a receipt for therapy. Any out-of-network therapist should be able to provide you with a superbill. If you have out-of-network benefits, you can submit the superbill to your insurance company in order to be reimbursed for therapy” says Laura Brassie of Ivory and Pine Counseling.
A superbill shows a line-by-line list of services you received from an out-of-network therapist. It’s a lot like a receipt, only more detailed. Your therapist can provide you with a superbill at the end of each session.
Superbills can be called “encounter forms” or “charge slips,” though these names aren’t as common as superbill.
A superbill is different from an invoice in that it is more detailed. A superbill includes extra information about your visit, such as diagnosis and procedure codes. This information is required to get reimbursed by your insurance.
In contrast, an invoice mostly contains financial information. It does not contain psychological information, or details of therapy.
In short, a superbill is not just a paid invoice. A superbill is a receipt that your insurance plan will accept and reimburse for out-of-network therapy services. Each superbill contains specific information, such as a billing code and diagnosis code, provider info, and your full legal name.
We’re providing a superbill example in case you’d like to see one. Just remember that your therapist will take care of filling everything out. All you’ll need to do is submit the superbill to your insurance (assuming your therapist doesn’t do this. See the example below.
“Many relationship and mental health therapists do not contract with health insurance companies for numerous, valid reasons... These therapists are called self-pay and out-of-network therapists. If you would like to seek reimbursement for all or a portion of what you have paid your out-of-network therapist from your health insurance plan, you can request what is called a superbill from your therapist” says Christy Kobe, LCSW in Utah. “After you submit this superbill to your insurance plan, the plan will reimburse you directly, in accordance with your insurance plan.”
As you can see, a superbill is important if you want to get reimbursed for your therapy sessions.
Your therapist or their office staff will be able to provide you with a superbill after each session. You don’t have to do anything other than ask for the superbill, and potentially submit it.
“The superbill must contain a few key pieces of info: the dates of service, the CPT code, which tells insurance what service was provided (i.e. 60 minutes of therapy), and the ICD10 code (i.e. the diagnosis code).” - Laura Brassie
Other pieces of information include your name, date of birth, address and phone number. The superbill should also include your therapist's National Provider Information (NPI number), and information about their practice.
Mental health practices should provide superbills for these reasons:
It’s ethical, reasonable, and helpful for mental health practices to provide the superbill. Not to mention that clients can’t create their own superbills. You should feel comfortable asking for a superbill at any therapist you decide to work with.
Submitting the superbill depends on your insurance company and their processes. The easiest way to submit your superbill is to send it directly from your therapists’ document portal on their website. Just know that some companies prefer that you mail the superbill, while others prefer that you fax or upload it.
Or, you can always pay for your therapy with Thrizer to automatically submit claims directly to your insurance after each session and expedite reimbursement.
Also, you may need to send an Explanation of Benefits (EOB) form along with the first superbill. If you have any questions about this, call the number on the back of your insurance card.
Once you’ve submitted the superbill to insurance, it can take 2-4+ weeks to hear back. Assuming there were no errors with your submission, it’s reasonable to expect reimbursement within 8 weeks from most insurances. Just understand that every insurance is different and your time may deviate from the average.
And if you don't want to wait for reimbursement, you can always use Thrizer Pay to just pay what you owe for the session, while they front your provider's fee, submit the claim, and wait for reimbursement for you.
If you made an error, beware that your insurance company will likely take their time in pointing this out. It’s not uncommon to get a letter or e-notice 6 weeks later informing you that the superbill was denied.
If your superbill is denied, you have a few options:
Remember that this is money you are entitled to as part of your out-of-network benefits. There may be hurdles along the road to getting reimbursed. But your efforts will be worth it once your claims are approved. If you need a helping hand, Thrizer can handle the entire-out-of-network process for you so you never have to deal with insurance again. .
Whatever you do, don’t give up until you have your money.
A superbill doesn’t contain any notes or details about what happens in therapy sessions. However, be aware that an official diagnosis (such as Generalized Anxiety Disorder) will be required for your superbill to be accepted and reimbursed by insurance.
If you’re concerned about privacy and confidentiality, let your therapist know. Consider paying fully out-of-pocket and foregoing use of your benefits altogether. This is the best way to maintain your privacy.
Submitting your superbill is all about getting reimbursed and making therapy affordable. If you want to improve your chances of reimbursement, there are a few things you can do.
Referral from a medical doctor: Your insurance company may require you to see a medical doctor to confirm your need for mental health services. Getting a referral gives your insurance the confidence that help from a mental health provider is necessary. To see if your plan requires a referral, call the number on the back of your insurance card. Be sure to ask for a list of medical doctors who can give you the green light for therapy.
Prior Authorization/Pre-Approval: Some insurance plans require you to talk to the insurance company to secure benefits. So, confirm with your insurance that they’ll foot the bill before you begin therapy. Remember to ask how many sessions are covered, parameters for inpatient treatment, and if you need approval for each session.
In-Network vs. Out-of-Network: If you’ve read this far, you’re likely looking for out-of-network mental health services. Be prepared to pay extra for this, and be sure to confirm all benefits with your insurance company before entering therapy. You don’t want to begin therapy and later be surprised by deductibles and other requirements. Know what to expect before your first out-of-network therapy session.
Keep the above points in mind and you’ll be well on your way to receiving affordable therapy.
In this blog, you learned what to expect when it comes to superbills for therapy.
You learned what a superbill is and isn’t, how to submit one to insurance, and a few other considerations. Armed with this knowledge, you can feel confident when seeking to be reimbursed for therapy.
Be sure to bookmark this page as a reference, and share it with your friends who’re seeking therapy reimbursements.
What is the CPT code?
You may see a CPT code on your superbill. A CPT code is a universal language of medical codes used to ensure that providers and insurers are on the same page when it comes to insurance billing. CPT codes are a safe way to transport medical data from your mental health provider to your insurance company.
What iss the difference between an invoice and a superbill?
An invoice is less detailed than a superbill. The superbill provides additional information such as diagnosis and CPT codes which are necessary to get your claim approved. An invoice is a purely financial document, whereas a superbill includes broader information.
What is an encounter form?
An “encounter form” is another name for a superbill. Yet a third name that is commonly used is a “charge sheet”. The encounter form is provided by the mental health provider and helps clients get reimbursed by their insurer for therapy services.
Is a superbill a bill for therapy?
A superbill is not a bill for therapy. The superbill acts as a receipt which proves therapy services were given by a provider to a patient. Your therapist or mental health provider will give you a superbill to help you get reimbursed by your insurance company for out-of-network services.
What is documented on the superbill?
A superbill is essentially an itemized list of services provided to a client during therapy. The superbill contains information about the patient, the practice, referring doctors, and CPT codes and ICD-10 codes, which tell what happened during the therapy session.
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This blog post is provided for informational purposes only and is not intended as legal, business, medical, or insurance advice. Laws relating to health insurance and coverage are complex, and their application can vary widely depending on individual circumstances and state laws. Similarly, decisions regarding mental health care should be made with the guidance of qualified health care providers. We strongly recommend consulting with a qualified attorney or legal advisor, insurance representative, and/or medical professional to discuss your specific situation and how the laws apply to you or your situation.
