Using a Superbill to Get Reimbursed for Therapy

Update as of September 2022

I now have an out-of-network calculator available on my website! You can check your benefits automatically here.

Therapy is an investment. Therapist fees range from $100 a session to $300 or more, depending on their location, specialty, and practice policies.

If this has made therapy feel out of reach or inaccessible, it may be time to explore the possibility of using your out-of-network benefits to help pay for therapy.

First, you want to determine what kind of insurance you have.  

If you have an HMO plan, you will likely not be able to get reimbursement for out-of-network therapy. If this is the case, you can either find a therapist who is in-network with your insurance, use an HSA card to pay for services, or pay out of pocket.  

If you have a PPO plan, you may be able to use your out-of-network benefits to help pay for your therapy.

Next, check your insurance benefits by reviewing your paperwork, logging into a member portal, or calling your insurance provider.

You’ll want to ask the following questions: 

  1. Does my plan include reimbursement for out of network mental health services?

    • Take a moment to confirm that your plan offers out-of-network benefits.

  2.  What information will you need from me and my therapist to reimburse me for services?

    • Likely your insurance provider will want your therapist’s National Provider Identifier (NPI) number as well as some information about their license.

  3. What is my deductible?

    • If you have a deductible to meet, you won’t start to get reimbursement until after you have paid that much out of pocket for services. It’s still important to submit your superbill if you’re working to meet your deductible so that once you do, the money can start rolling in!

  4. What is the reimbursement rate for out of network mental health services?

    • Plans vary and you may be reimbursed anywhere from 30% to 90% of the fees for your therapy sessions. Know the facts ahead of time so you can be aware of how much therapy will cost when it’s all said and done.

  5. How can I submit my superbill once I have it?

    • The document you will need to get reimbursed is called a superbill – it’s basically a dated invoice including the dates of your session, your diagnosis code, and how much you paid for therapy. Confirm with your insurance the best way for you to submit this, whether it’s uploading it online or faxing it in.

After confirming that you have out of network benefits and understanding what your reimbursement rate will be, let your therapist know that you would like a superbill to submit to your insurance provider.

If you have not already received a diagnosis, your therapist will likely have a conversation with you about this at this time as most insurance providers require a diagnosis on file in order to reimburse you for your sessions.

Your therapist will then generate a superbill for you after sessions which you can then directly submit to your insurance provider. I recommend submitting your superbill once a month, or after every four sessions.

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Copyright 2022 Summer Forlenza