Superbill Therapy: How to Get Money Back for Sessions

Superbill therapy means you pay your therapist yourself, then send your insurance company a detailed receipt called a superbill. If your plan has out-of-network benefits, the insurer may pay part of the cost back to you. It is a common way to see a therapist you like who does not take your insurance.

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What is a superbill for therapy?

A superbill is an itemized receipt your therapist gives you after you pay for sessions. It has the details your insurance company needs to process a claim. A regular receipt only shows that you paid. A superbill shows what the visit was, who provided it, and why.

HealthCare.gov describes a claim as a request for payment that you or your provider submits to your health insurer. With superbill therapy, you are the one who submits it.

A therapy superbill usually includes:

• Your name, date of birth and address
• The therapist's name, license type, address and phone number
• The therapist's National Provider Identifier (NPI) and tax ID
• The date of each session
• A procedure code for the type of session, for example a 50 minute therapy visit
• A diagnosis code
• The fee for each session and the amount you paid

If any of these are missing, the insurer may send the claim back. Check the superbill before you send it.

How does superbill therapy work, step by step?

Most people follow the same steps.

1. You see a therapist who is out of network with your plan.
2. You pay the full session fee at the time of the visit.
3. The therapist gives you a superbill, often once a month.
4. You send the superbill to your insurer, usually through their website, app or by mail.
5. The insurer reviews the claim and decides what it will cover.
6. If it covers part of the cost, the insurer sends you a check or a direct deposit.

Some therapists will send superbills automatically. Others only send one if you ask. Ask at your first appointment so you know what to expect.

Does my insurance cover superbill therapy?

It depends on your plan. Superbills only lead to money back if your plan has out-of-network benefits for mental health visits. Many PPO plans include them. Many HMO and EPO plans do not.

Before your first session, call the number on your insurance card. Ask whether your plan covers out-of-network mental health visits and what you would pay. Then ask these follow-up questions:

• Do I have a separate out-of-network deductible? How much of it have I met this year?
• After the deductible, what percent of the cost do you pay?
• Is there a maximum amount you will pay per session?
• Do you need a referral or approval before I start?
• How long do I have to submit a claim after a visit?

Write down the name of the person you spoke to and the date. If a claim is denied later, that note helps.

You can also see how plans like yours work on our insurance pages.

How much money will I get back?

There is no single answer. The amount depends on three things in your plan.

The first is your out-of-network deductible. A deductible is the amount you pay for covered services before your plan starts to pay. Out-of-network deductibles are often higher than in-network ones. Until you meet it, you may get nothing back, even though the insurer still counts your sessions toward it.

The second is your coinsurance, the share of the cost the plan pays after the deductible.

The third is the "allowed amount." This is the price your insurer thinks a session should cost. If your therapist charges more than that, the plan pays its share of the lower number, and you cover the rest.

So if your therapist charges more than the allowed amount, your money back will be smaller than you expect. Ask your insurer what the allowed amount is for the procedure code on your superbill.

For a wider look at prices, see how much therapy costs.

How do I submit a superbill to insurance?

Log in to your insurer's member website or app. Look for a section called "submit a claim" or "member reimbursement". Many plans let you upload a photo or PDF of the superbill. Others use a paper claim form that you mail with the superbill attached.

A few tips make it go faster:

• Submit once a month. It is easier to track than one claim per session.
• Keep a copy of every superbill and every form you send.
• Check the insurer's deadline. Some plans only accept claims for a set time after the visit.
• Watch your mail and email for an Explanation of Benefits. It shows what the insurer paid and why.

If the insurer denies a claim, read the reason on the Explanation of Benefits. Often it is a missing detail, like the therapist's NPI. Ask your therapist for a corrected superbill and send it again.

Is superbill therapy worth it?

It can be, if you want a therapist who does not take your insurance and your plan has out-of-network benefits. You get to pick the therapist who fits you best.

There are tradeoffs. You pay the full fee up front, and the money comes back later, sometimes weeks later. If you have not met your out-of-network deductible, you may pay most of the cost yourself for a while. And because a superbill includes a diagnosis code, that code becomes part of your insurance record, the same as it would with an in-network visit.

If paying up front is hard, ask the therapist about a sliding scale fee, or look for someone in your network instead.

Common questions

Can any therapist give me a superbill?

Most licensed therapists in private practice can write one. Some do it for every client who pays out of pocket. Ask before your first session so there are no surprises.

Do I need a diagnosis to use a superbill?

Insurers usually need a diagnosis code to pay a claim for therapy. Your therapist decides which code fits after talking with you. If you have questions about what goes on your record, ask your therapist before they write the superbill.

Can I use a superbill with an HSA or FSA?

Often, yes. A superbill can serve as the receipt many health savings and flexible spending accounts ask for. Check your account's rules, since each plan sets its own.

How long does it take to get paid back?

It varies by insurer. Some pay within a few weeks. Others take longer, especially if they ask for more information. Your insurer's member services line can tell you the usual time.

Not sure where to start? Tell saycalm what's going on, for you or someone you love, and we'll explain your options and help you find a provider who fits. Start a conversation