Though your health insurance plan may include mental health coverage, accessing an in-network mental health professional directly through your insurance plan can be very difficult.
Luckily, there’s another option that can help you receive reimbursement for mental health care from your insurance without having to find an in-network provider: out-of-network session reimbursement using what healthcare professionals call a “superbill.”
Navigating any sort of insurance coverage and reimbursement can be tricky, so we’ve reached out to therapist and group practice owner Elise Braganza, LMFT to get the details. In this article, Braganza will help us learn what a superbill is, how to know if you’re eligible for reimbursement, and how you can receive a superbill and get on the path to lower cost mental healthcare.
What is a superbill?
Simply put, a superbill is an itemized receipt of services provided by a care professional.
This document contains details such as the client’s identifying information, the care provider’s identifying information, dates, procedures, diagnostic codes, and fees that the client paid for services. A superbill does not contain any notes or details about what happens in therapy sessions, but care seekers should be aware that an official diagnosis will be required in order to submit this superbill to an insurance provider.
What makes a superbill “super” is the information it contains that is helpful for insurance providers. Using a superbill, “all the information insurance providers are requesting can fit onto one page. That makes it ‘super’ for them to easily access the information they need,” Braganza says. Most insurance providers will take any format of superbill that contains all required information, but some will require you or your care provider to fill out their own document for reimbursement.
The “bill” term also applies to insurance providers rather than care seekers. Braganza suggests you think of it like a bill that you’re sending to your insurance provider for reimbursement rather than a bill that your care provider is sending to you.
How do I know if I’m eligible for reimbursement using a superbill?
When it comes to how much you’ll be reimbursed for services, Braganza notes that unfortunately every insurance company and every plan is different, so you’ll need to get specific with your insurance provider to determine what will and will not be covered and reimbursed. Braganza also notes that sometimes insurance providers will only offer coverage for specific mental health diagnoses, so it’s a good idea to ask for a list of covered diagnoses from your insurance provider up front.
Braganza notes that there are some things you can do to try to determine your eligibility using materials you may already have on hand. When reviewing your insurance coverage documentation, you’ll want to examine your plan’s coverage for “out of pocket” or “out of network” (OON) mental health services. “Make sure you have a clear understanding of your deductible and if you qualify for a percentage or a flat rate (of reimbursement) per session,” says Braganza.
As with most things having to do with health insurance coverage, Braganza reminds us that the easiest way to get a clear answer is to give your insurance provider a call and ask for specifics as to what will be covered and what you’ll need to provide to get reimbursed. If your insurance does accept superbills for reimbursement, ask them what information they specifically need included on the superbill so you can inform your therapist and so you know what kind of information you’re consenting to sharing with your insurance.
Below are a few sample questions you may want to ask when contacting your insurance provider about OON mental health coverage using a superbill:
- Does my current plan provide any coverage for services provided by out-of-network mental health care providers? If so, what is that coverage?
- Do you accept superbills in order for me to be reimbursed for out-of-pocket expenses for covered services?
- What information will need to be provided on a superbill in order for me to receive reimbursement?
- What mental health diagnoses are covered by my insurance plan?
- How long do I have to submit my superbill to you after services are provided?
- How will my reimbursement be delivered to me (via check or otherwise) and about how long will it take?
- Is there a way for me to track the status of the superbill I’m submitting for reimbursement?
How can I get a superbill?
Like all aspects of therapy, when inquiring about superbills the best approach is to have clear and open communication with your care provider about what is available and what to expect. Braganza notes that unfortunately not all mental health providers offer superbills to their clients due to potential issues with insurance providers, so it’s best to ask about this right away as you’re interviewing potential care providers. She also mentions that your health care provider should never charge you for a superbill– think of it like an itemized receipt issued after a mental health service has been provided and paid for by you.
If your care provider does provide superbills, be sure to also ask how often they will be generated and whether they will be sent to you or directly to your insurance provider. You’ll want to be sure that whether weekly, bi-weekly, or monthly, the frequency at which your care provider sends superbills matches the requirements of your insurance plan– sometimes if a superbill is received too late, coverage will be denied.