How to Submit a Superbill for Out-of-Network Therapy Reimbursement
If you’re seeing me (or any out-of-network therapist), you may be able to get partial reimbursement from your insurance. A superbill is what you send to your insurer so they can process your claim. Below I explain what a superbill is, what to ask your insurance company, and how to submit it step by step.
For those who are not big fans of paperwork, it can seem overwhelming, but take it one step at a time and reach out if you have any questions.
What is a superbill?
A superbill is an itemized receipt with the details your insurer needs to process an out-of-network claim. You pay me for sessions, then use the superbill to request reimbursement from your plan.
A complete superbill includes:
Your name and date of birth
My name, credentials, practice address, and NPI
My practice tax ID
Diagnosis code(s) using ICD-10, if included
Dates of service, CPT codes, session length, and the fee you paid
Place of service, for example in person or telehealth
Before you submit: check your benefits
Take a breath. And then call the member services number on your insurance card and ask:
Is there a deadline there a deadline for submitting a superbill based on the service date?
Do I have out-of-network benefits for outpatient psychotherapy
What is my deductible and how much of it have I met this plan year
After my deductible, what percentage of the allowed amount is reimbursed
Any limits on number or frequency of sessions
Do I need preauthorization or a referral
Which CPT codes are covered, for example 90791, 90834, 90837, 90847
Are telehealth sessions covered and do they require a modifier like 95
How do I submit claims: portal, app, mail, or fax
Typical processing time and how reimbursement is issued
Write down the date, the representative’s name, and any reference number.
How to submit
Get the superbill from me
My client portal automatically generates a superbill on the 1st of each month for the month prior. For example, on October 1st, your September superbill will be available when you log into the client portal.
Attach proof of payment if requested
Most plans only need the superbill. Some ask for a receipt or credit card statement.Submit through your insurer’s preferred method
Online is usually fastest. If mailing, use their claim form and attach the superbill. Keep copies.Track your claim
Note the submission date and follow up if there is no movement within the stated window.Review the Explanation of Benefits (EOB)
The EOB shows the allowed amount, what went to your deductible, and what will be reimbursed.Appeal if needed
If denied or underpaid, call to ask what is needed to reprocess the claim.
Understanding reimbursement
Your insurer sets an allowed amount for each CPT code. After you meet your deductible, your plan reimburses a percentage of that allowed amount. If my fee is higher than the allowed amount, the difference is not reimbursed.
Example
My session fee: $250
Plan’s allowed amount: $160
Reimbursement rate after deductible: 70 percent
You would receive: $112
Common reasons for delays or denials
Missing NPI or tax ID
I can reissue a corrected superbill
Incorrect member ID or date of birth
Update and resubmit
Code not covered or missing a required modifier
Ask which code or modifier is acceptable, then resubmit
Out-of-network benefits inactive or deductible not met
Refile after benefits are active or the deductible is met
Diagnosis required
Some plans require an ICD-10 diagnosis on the superbill
Privacy considerations
If your plan requires a diagnosis to reimburse you, it will appear on you
Overwhelmed?
It can feel like a lot, but once you’re in the flow it’s not as painful as it may seem. Feel free to reach out if you have any questions.