What the Heck is a Superbill?

Navigating Out-of-Network Coverage for Therapy

If you’ve ever been to therapy and tried to figure out how your insurance works—or more specifically, how to get them to cover some of the costs—you might have heard the term superbill. It sounds a little complicated, but trust me, it’s not that bad!

What’s a Superbill?

A superbill is basically a fancy receipt your therapist gives you after a session. But instead of just saying, "Hey, you paid for a session," it includes a bunch of details that your insurance company needs to know in order to decide how much (if anything) they’ll reimburse you.

Here’s what you'll typically see on a superbill:

1. Provider’s Info: The name, address, and credentials of your therapist (e.g., Licensed Marriage and Family Therapist).

2. Client Info: Your name, birth date, etc.

3. Dates of Service: The dates you had therapy sessions.

4. CPT Codes: These are codes that describe what kind of therapy you had (e.g., individual therapy, family therapy).

5. Diagnosis Code: This is a code that represents why you're in therapy (e.g., anxiety, depression, trauma).

6. Session Fees: How much the session cost.

7. Payment Info: Whether you’ve already paid or if your insurance was billed directly.

How Can a Superbill Help with Out-of-Network Therapy?

A superbill is your ticket to possibly getting some of your therapy costs covered, even if your therapist isn’t on your insurance’s list of approved providers, depending on your individual insurance’s out-of-network coverage policy.

Here’s how to make it work:

1. Check Your Insurance Benefits:
   First thing’s first—call your insurance and ask about your out-of-network benefits. You’ll want to know things like:

   • What percentage of therapy costs are covered if the therapist isn’t in-network?

   • Is there a deductible or co-insurance for out-of-network providers?

   • Do they cover a certain number of sessions each year?

   • Do they need you to get pre-approval before starting therapy?

2. Ask for a Superbill After Each Session:
   After your therapy session, just ask your therapist for a superbill. Most therapists are used to providing these for clients seeking reimbursement.

3. Submit the Superbill to Your Insurance:
   Once you have the superbill, you’ll submit it to your insurance company. Most insurance companies let you submit claims online or through an app, but you can also mail it in if that’s easier. Be sure to include:

   • The superbill itself

   • Any forms your insurance requires for submitting claims (sometimes they need a special claim form, so check first).

   • Keep a copy of everything you send, just in case!

4. Wait for Reimbursement:
   After your insurance processes the claim, you’ll get an Explanation of Benefits (EOB). This will tell you how much they’ll cover (if anything) and how much you owe. They might send you a check, or you might see the payment go directly to your bank account.

5. Appeal if Needed:
   If your insurance only reimburses part of the cost—or denies the claim altogether—don’t give up. You can appeal! Review your plan benefits and make sure everything was submitted properly. If you think your claim should have been fully covered, it’s worth reaching out to your insurance company to ask for clarification or submit additional info.

In a Nutshell:

Navigating out-of-network therapy doesn’t have to be stressful. We hope this step-by-step breakdown makes it easier for you to get the therapy you need and afford the care that works best for you.

Having the right therapist is so important for your mental health, and insurance should help you get the care you need, no matter whether they’re in-network or not. Don’t let the insurance details stop you from finding the therapist who’s the best fit for you!

Willow & Moss Counseling – Compassionate Therapy in Cherokee & Cobb County, Serving Woodstock, Holly Springs, Canton, Kennesaw, and Marietta.