What is a Superbill?
What is a Superbill?
All of our clinicians are out of network with insurance providers. This is for many reasons, but often because insurance tries to limit the number of sessions you are provided regardless of what you are needing. Being out of network means that we are not connected with any insurance provider nor do we bill any insurance directly.
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What we are able to offer is a Superbill. This is a statement that lists your charges for sessions that you are able to submit to your insurance for possible reimbursement. It is not a guarantee that your insurance will reimburse but we are able to provide a superbill upon request. Many individuals choose to submit them monthly or quarterly.
How do I know if my insurance will reimburse?
Prior to starting services, it can be helpful to call your insurance provider and ask about your out of network benefits for mental health care. This will give you an idea of if and how much your insurance provider will reimburse if you submit a superbill.
Do I have to pay for sessions up front?
Yes. You will be responsible for the costs of services at the end of each session. Your card on file will be charged automatically.
Do I need to ask for a superbill or will my therapist send it regardless?
You will need to notify your therapist that you need a superbill and how frequently you would like to receive them (monthly, quarterly, etc).
What information is displayed on a superbill?
Below is a list of common information that may be displayed on your superbill. This is to ensure that your insurance carrier has the information needed to determine eligibility for reimbursement.
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Client Identifying Information (name, DOB, address, etc).
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Therapist information (name, address, contact information, license number, etc).
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Client diagnosis. Insurance companies need information on why you sought out mental health services and justify this through a diagnosis.
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Dates of services rendered: all service dates in which you paid for a service will be listed on the itemized statement, in addition to the procedure code that details what kind of service was rendered.
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Procedure Code: the CPT (current procedural terminology) code is a code that is used to identify what time of service was performed (45 minute individual session, 80 minute couples session, etc).
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Itemized costs of services: the cost of each service will be listed by each procedure code, as well as a total amount of fees paid by you.
How much will insurance reimburse?
Determining what your insurance will reimburse you for includes a lot of factors.
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Your expected coinsurance or copay for out-of-network services (the portion you are responsible for paying)
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What your insurance would cover for an in-network provider
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If you have met your out-of-network deductible and out of pocket expenses
You may pay $150 for your sessions. Your insurance carrier may determine that they are willing to pay $100 per 50 minute session, and your expected out-of-network coinsurance is 40 percent (40%). This means that your insurance provider will cover 60% of the $100 they deem eligible for reimbursement, therefore your insurance provider may reimburse you $60 per session.
How long do I have to submit a superbill?
Time limits are set by the insurance provider. Reach out to your insurance provider to inquire how much time you have to submit a superbill after a service has been rendered.
What if my request for reimbursement was denied?
There should be a reason for denial in your explanation of benefits (EOB). Your insurance provider is required to explain why it was denied. It’s possible that your insurance provider may require more information before considering reimbursement. Even if a claim is denied, you have the option to appeal it.