Using Superbills for Therapy: How To Use Out-of-Network Benefits for Mental Health
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Even though finding a therapist is a difficult part of getting started in mental health care, finding someone who takes your insurance is even harder. Thankfully, there are a few options when it comes to accessing care. One of those options for people with insurance coverage is using your out-of-network benefits to pay for therapy.
To utilize these benefits, your therapist can issue you a “superbill,” which I’ll explain below. In this article I’ll also cover what it does, how submitting it to your insurer works, and how to use it to get reimbursed for mental healthcare services.
In-network versus Out-of-Network providers
When you look up a provider on your insurance’s website, those are called in-network therapists. They are therapists that the insurance works with at a negotiated rate, to see clients that are covered by that insurance. In-network therapists are typically more affordable than out-of-network because you typically only pay a co-pay for each of your sessions. The insurance company collects your co-pay (in addition to your, probably very high, monthly premium) and then pays the therapist their negotiated rate. Many therapists see insurance clients at a cut to their own personal income, because many times insurance rates are lower than market price. Superbills are one way that out-of-network providers may also be made affordable for individual therapeutic treatment.
Why would anyone use Out-of-Network benefits?
Utilizing in-network therapists limits your choice for which therapists you’re able to see, what types of therapy you have access to, and limits your access to privacy. In-network therapists are required to assign a diagnosis and treatment plan to you from day one—they must provide documentation that you are in “true need” of mental health treatment. Out-of-network providers are not required to do this. We can take our time in assessing your needs, and gathering information that informs your treatment plan, because we are not beholden to strict insurance requirements and timelines.
What is a superbill?
A superbill is a document that that looks a lot like a standard invoice or receipt of services. It contains information about the services you received from your therapist or mental healthcare provider. It includes:
Dates of sessions
Type of service provider, including diagnosis code
The full fee for services
The total amount billed
Contact information about your therapist and their practice
Your date of birth, legal first and last name (needed to match your insurance), and contact info
Your therapist or mental health provider's NPI number
You can use a superbill to request reimbursement from your insurance company if your therapist is out-of-network.
How do out-of-network benefits work?
Suppose you have out-of-network benefits through your insurance plan. In that case, you can use a superbill to request reimbursement for therapy services. Some health insurance plans may offer partial reimbursement for out-of-network services by mailing you a check. You may be required to pay for the session upfront and then submit a claim for reimbursement afterward. (Your insurance provider can tell you what forms you need to submit regarding your medical bill.)
If you have a PPO or POS health insurance plan, you could get some money back for mental health out-of-network services. Partial reimbursement can make mental health services more affordable. These benefits vary depending on your insurance plan, but they generally cover a percentage of the cost of therapy.
How to use a superbill or out-of-network benefits to pay for therapy
First things first, understand your out-of-network benefits with your insurance policy. You want to look up your out-of-network deductible and any coinsurance you may have for mental health or behavioral healthcare. Then, you can call your insurance company by finding the phone number on the back of your insurance card. If you have a healthcare navigator or navigation platform, you can also ask them for help.
Questions to ask your insurance company:
Has my deductible been met this year?
What is my out-of-network deductible for (outpatient) mental health or behavioral health?
What is my out-of-network coinsurance, if any?
Do I need a referral from an in-network provider to see an out-of-network therapist?
What is the process for submitting claim forms for reimbursement?
Why do some therapists use superbills?
Using insurance can be difficult for both the therapist AND the client. For some clinicians like myself, using superbills as opposed to being an in-network provider is an accommodation for my ADHD and Autism.
Using a Superbill:
Makes therapy more affordable
Is a request made by you as a patient or member (giving the power back to you as a consumer!)
Requires specific information to be documented on a reimbursement form
Is submitted to the insurance company so you can get reimbursed
Deductibles, coinsurance, and health savings accounts
What are deductibles and coinsurance? How can you use insurance benefits like an HSA or FSA towards a superbill?
Coinsurance (or copay): Coinsurance is the percentage of the service fee that you're responsible for paying. For example, let's say you have a coinsurance rate of 20%. If you have a medical bill for $100, you would be responsible for paying $20 (20% of the total cost). Your insurance company would pay the remaining $80.
Coinsurance is a health insurance cost-sharing mechanism where you and your insurance company both pay a portion of your healthcare costs according to a predetermined percentage.
Deductible: A deductible is a set amount of money that you have to pay out of your own pocket before your health insurance starts covering your medical expenses. Not all insurance plans have deductibles.
HSA: An HSA (Health Savings Account) is a type of savings account you can use to pay for medical expenses. You contribute money to the account before taxes are taken out of your paycheck, and you can use the funds to pay for medical expenses, such as doctor's visits, therapy, prescriptions, and certain medical procedures.
FSA: An FSA (Flexible Spending Account) is a type of savings account that allows you to set aside pre-tax money to pay for eligible medical expenses, including therapy.
How do I ask my therapist for a superbill?
If you want to see an out-of-network therapist, ask if they can send the medical bills or claims to your insurance company for you. Some therapists will, but often you have to do it yourself. This is an important step for getting reimbursed for paying the full fee for services.
Your therapist or provider will give you a superbill form that shows the total service fees and how many sessions you had. You have to send this form to your insurance company at the end of every month.
Here are the steps you can take:
Attend your therapy session and pay for it out-of-pocket. Be sure to obtain a superbill from your therapist that lists all the necessary information, including the provider's name and NPI number, the services provided, and the costs associated with each service.
Submit the superbill to your insurance company along with an insurance claim form. The claim form will vary depending on your insurance provider, but you can typically find it on their website or by calling customer service.
Wait for your insurance company to process the claim form. The time it takes for the claim to process can vary depending on your insurance provider, so it is best to check with them for an estimated timeline.
Receive reimbursement! If your insurance plan offers out-of-network coverage, they will typically reimburse you for a portion of the cost of therapy. The reimbursement amount will depend on your specific plan, so always check with your insurance provider to understand your benefits.
Using a superbill for out-of-network benefits can help reduce the cost of therapy, but it’s important to check with your individual insurance company to make sure they provide out-of-network coverage.