Insurance Superbills and Out of Network Therapy
Here at Riverbank Therapy, we provide courtesy billing for clients who want to use their in or out of network insurance benefits (read more about this below, and more about our fees and billing practices here). However, many therapists in the field opt to provide clients with superbills rather than doing courtesy billing.
Even if you don’t seek therapy at Riverbank, we’d love to support you in understanding what a superbill is, how they work, and what out of network reimbursement can look like with superbills. We want to support you in feeling confident navigating the financial side of therapy services.
What is a superbill?
A superbill is a receipt from your therapist provided to you after a session has occurred. You can submit your superbill to your insurance carrier for potential out of network reimbursement.
For successful claims processing with your insurance, the superbill must contain at least:
your name, date of birth, and insurance ID number,
the date of service for the session,
the CPT code for the session (for most therapy sessions this is 90791, 90837, or 90834), including any modifiers for the session if it was a telehealth session,
your diagnosis (yes, even with out of network billing, you must have a diagnosis on the superbill for insurance reimbursement),
the providers name, license number, NPI number, and tax ID number,
the fee for the session, and how much you paid.
Some insurers may require more information on a superbill, but this is typically what is required.
Why is my therapist giving me a superbill?
Therapists who are out of network with insurance companies may choose to provide you with a superbill rather than doing courtesy billing (more on courtesy billing below).
Therapists often choose to do superbills because they do not have to navigate the complexities of insurance systems and incur less risk financially. With superbills, the therapist collects the full session fee from you up front, and then you do the legwork to potentially get reimbursed by your insurance company.
What if I don’t HAve or want a mental health diagnosis?
We understand that not everyone wants to have a diagnosis in their medical record. Much of what brings us to therapy is just a result of being a human, and labeling your experience with a diagnosis is not always helpful.
However, a diagnosis is required for in-network and out of network billing for services to be reimbursed by your insurance company. Sessions will not be covered by insurance without one. Unfortunately, this is how the insurance industry in the United States functions, regardless of how your provider handles billing.
If you don’t want to have a diagnosis on file, you will want to opt for “private pay”. This is effectively just paying out of pocket for therapy sessions and not involving insurance at all.
How do I submit a superbill?
Different insurers have different processes for submitting superbills. Most of them have an online member portal where you can fill out a claims form requesting reimbursement and include the superbill (with all of the information listed above, and anything additional your insurance carrier requires). Then you wait for them to process the claim and determine how much was covered by your insurance.
Some HSAs also require you to submit a superbill when using HSA funds to pay for therapy sessions. Check with your specific insurance plan and HSA to find out what is required.
How much will my out of network insurance cover when I submit a superbill?
This depends on your plan. See more on our Insurance 101 page for information about insurance plans, deductibles, coinsurances, and the difference between in and out of network providers.
When you submit a superbill, you’re doing it because your therapist is out of network with your plan. Your therapist should quote you an estimate of your benefits before your first session so that you have informed consent about what therapy will cost for you. Not all providers do this though, so we recommend also calling your insurance carrier to find out what your out of network coverage is.
Most out of network plans have a deductible that you have to hit before insurance begins covering anything. For example, you may have a $3000 out of network deductible. This means you have to use $3000 worth of medical services before insurance will pay anything. (More on this on our Insurance 101 page). Once you hit your deductible, most plans have an out of network coinsurance. For example, after paying $150 per therapy session until you hit the $3000 deductible, you might then have a 50% coinsurance per session. This means you would pay $75 per session, and your insurance would reimburse you for the other $75.
However, if your provider is doing superbills, you would have to pay their $150 fee up front, even after you’ve met your deductible, then submit the superbill to your insurance, and wait for your insurance to reimburse you for the $75 (50% coinsurance) that they cover.
Again, we recommend reaching out to your specific insurance carrier to find out what your out of network coverage is.
How do I get reimbursed by my insurance company?
Most insurance companies mail you a check for the covered amount after you submit the superbill and they process the claim. This typically takes around 30 days after you submit the superbill.
What is courtesy billing?
Courtesy billing means that you don’t have to deal with superbills! Courtesy billing means that your provider submits claims to your insurance on your behalf, and then the provider waits for reimbursement.
For our above example, with a superbill, after you met your deductible, you would have to keep paying your therapist $150 out of pocket each session, then wait for your insurance to reimburse you for the $75 covered after your submit the superbill.
With courtesy billing, once you’ve met your deductible in the above example, you would just pay the 50% coinsurance ($75) up front to your therapist, and then your therapist would wait for insurance reimbursement instead.
We do courtesy billing at Riverbank Therapy. We find it to be easier for our clients and increases the accessibility of therapy. More information on how we handle this on here.