When it comes to insurance, premiums, medical bills, and anything else that’s healthcare-related, many people feel confused and overwhelmed. While yes, things can be convoluted and confusing, most of the time you just need a quick, simple, and easy-to-understand explanation to make sense of it all. This is true when it comes to the idea behind a Superbill, too. If you’ve heard the term, but you still find yourself asking what is a Superbill, keep reading.
We’re explaining what a Superbill is, how it works with your insurance plan, and how you can submit one if you’re looking to be reimbursed for out-of-pocket costs to on-site or online therapy. Are you a therapist who needs help creating a Superbill? We’ll look at that, too.
Read on for the ultimate guide to Superbills.
Superbill Definition
A Superbill definition is simple to understand. Superbills are essentially just receipts for therapy or other healthcare services you get from an out-of-network therapist, counselor, or doctor. Therapy Superbills are created so you can submit an official receipt of your qualified expenses to your health insurance company for reimbursement. Once the insurance company receives your Superbill, they’ll determine how much, if any, the money you’re entitled to.
How do Superbills work?
Superbills can also be referred to as a claim form, fee ticket, encounter ticket, invoice, receipt, or statement of service. They differ from normal claims because of how they’re handled by insurance companies.
Normally, a therapist would submit a claim to an insurance company, which will pay them directly for their services. With a Superbill, however, you’re paid by your insurance company as reimbursement for services you’ve already paid the therapist. Most often, you would have paid them at the time of your appointment. This is to protect the therapist and guarantee they’re compensated.
If an insurance company gets a Superbill, they generally assume the health care provider has been paid and that the amount submitted on the Superbill should be paid out to you.
Why are Superbills used for therapy?
Wondering what is a Superbill in therapy and why they’re used? Sometimes therapists want to use Superbills because the process can be quicker and easier than becoming an in-network provider. Of course, actually being on an insurance provider panel can be great — it allows therapists to be more accessible to those who have insurance or to those who can’t afford to pay out-of-pocket for therapy.
“Superbills can be a great way to be fully or partially reimbursed for the cost of your out-of-pocket therapy expenses. Therapy can often be a luxury reserved for those with the privilege to afford it; however, the option of using a superbill can truly make therapy completely affordable to all.”
Talkspace Therapist Ashley Ertel, LCSW, BCD, CDBT
The process to get on an insurer’s provider panel isn’t always as easy as it could be. It can take a long time, and it can be complicated. Especially if there are multiple insurers in the area. Each provider panel requires a separate and individual application. Superbills let therapists take insurance from patients even if they’re not on a preferred provider in-network list.
Superbills can be an effective option for therapists who:
Are busy and don’t have time to get on a provider panelDon’t have any interest in joining a panelHaven’t been accepted to a provider panel yetDon’t want to join every provider panelWould like to be on multiple panels, but don’t have the resources or time to join them all
What’s Included in a Superbill?
A Superbill receipt (also known as a statement) will have a few key pieces of information, including:
Date or dates of service or services Fee for servicesInformation about the therapist or practiceInformation about the person receiving treatmentA formal CPT code or codes — based on the American Medical Association code; used to identify and treat medical procedures and illnessesA diagnosis code or codes — ICD-10 code; DXInformation about a referring doctor (if any) Total amount billed Therapist’s credentials
How to interpret one as a client
If you’re getting a Superbill from your therapist, there’s some important patient information that needs to be included. All the above must be present, along with specific demographic information that your therapist may or may not have about you.
Keep in mind, if they don’t take insurance, a therapist might not have all the necessary patient information from you to completely fill out the Superbill. Make sure that your Superbill has your first and last name, address, phone number, date of birth, and ICD-10 code.
If you need a Superbill from your therapist, know that many don’t openly offer them. It’s perfectly fine for you to request one, though. Once you have the Superbill and you’ve verified all the information is there, you can easily submit it to your insurance. It is important to note that a Superbill does not guarantee reimbursement from your insurance company. Reimbursement depends on several factors, including your insurance provider policies.
“Medical documentation can sometimes feel overwhelming. Think of your superbill as a receipt for the therapy services you have paid for. It will include the dates of your sessions along with the billing codes and the price paid. It will also include contact information for your therapist in case the insurance company has additional questions.”
Talkspace Therapist Ashley Ertel, LCSW, BCD, CDBT
How to make one as a therapist
Once you understand the Superbill definition, making one for a client isn’t hard. You can find software that makes the process incredibly simple. If you go this route, be sure that the software’s designed with privacy protection safeguards in place. Any name brand, good quality software will do this, but it’s something to be aware of when you’re looking.
You can also make your own Superbill template easily. To create this document for insurers, you just need to list some detailed, specific information about the services you’ve provided. You will want to include some or all the following information.
Information about you and your services:
Your first and last nameYour business nameYour mailing address and other contact information (email and phone number)Your Employer Identification Number (EIN) or Federal Tax ID NumberYour license number authorizing you to practice in your stateYour signature
Information about your client:
Your client’s first and last nameYour client’s date of birthThe diagnosis code (ICD-10 Code)
Information about the services:
Date of serviceThe Current Procedural Terminology (CPT) to accurately describe services — note the codes for psychological services can be differentA detailed description of servicesCharges for servicesThe Place of Service Code — commonly used codes for therapists are: 2 (telehealth)11 (office)12 (home)
Note some of the following additional tips:
You might also include details about diagnosesYou’ll likely need to submit individual Superbills for each sessionBe sure you’re issuing ICD-10 Superbills using the latest versions of diagnostic codes
Does Insurance Cover Superbills?
Either you or your therapist might submit a Superbill. Regardless of who does so, the insurer will remit payment to the client. They’ll assume that it’s for reimbursement of services you’ve already paid. Your insurer will verify any healthcare benefits you have to determine any amount that’s due.
Your insurance will consider the following:
If you have a copayment: If you have a copayment due for mental health care services, the reimbursement will be factored by subtracting whatever that amount is from the total amount you paid your therapist.If you have any deductible: Any deductibles need to be met before reimbursements are made. After the deductible amount is surpassed, your insurance will begin to reimburse you for additional payments.How timely the Superbill was filed: Insurance companies allot a certain timeframe for Superbills to be turned in. If you submit a Superbill past that deadline (for example, it could be 90 days after the date of service), your healthcare claim will be denied.
How to Submit a Superbill
To submit a Superbill, you need to understand the specific requirements set forth by your insurance company. You should call your insurer directly to verify your benefits and submit the Superbill. To contact your insurance, check the back of your membership card and look for the number listed for “Member Services” or “Members.”
Frist, you’ll want to verify:
What your out-of-network insurance benefits for therapy areHow you should submit your SuperbillThat the insurance company has your home address — this is very important if you’ll be receiving a check for your reimbursement
Next, you should ask:
Do you need pre-authorization?Do you have a co-payment?Do you have a deductible? If so, what is it?How much have you earned toward your deductible this year?Do you have co-insurance?How long do you have to meet the “timely filing” window?What is the proper fax number and/or mailing address to submit the Superbill?Does the insurance company have a portal you can use to electronically submit Superbills? If so, how can you gain access to it? You might need an invite.
*NOTE: You may want to review the above questions with your insurance provider before you have your first appointment so you’ll be able to estimate what your therapy will cost you.
To submit the Superbill:
You might be able to submit your Superbill in the following ways:
Fax the Superbill with a cover letter to your insurance companyMail the Superbill to your insurance companyUpload the Superbill to the insurance company’s portal
“For my clients who have been able to utilize a superbill for reimbursement, it was as simple as faxing the required documentation to their insurance company for reimbursement. The first step is to call your insurance provider to determine how they would like to receive the superbill and if they have any additional requirements.”
Talkspace Therapist Ashley Ertel, LCSW, BCD, CDBT
With the help of a Superbill, you may be able to more affordably start getting the therapy you need and start seeing a therapist who can help you change your life for the better.
Sources:
1. Are You a Covered Entity? | CMS. Cms.gov. https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/HIPAA-ACA/AreYouaCoveredEntity. Published 2021. Accessed December 4, 2021.
2. ICD-10-CM Official Guidelines For Coding And Reporting FY 2020. Centers for Medicare & Medicaid Services; 2020. https://www.cms.gov/Medicare/Coding/ICD10/Downloads/2020-Coding-Guidelines.pdf. Published 2020. Accessed December 4, 2021.
3. CPT – CPT Codes – Current Procedural Terminology – AAPC. Aapc.com. https://www.aapc.com/resources/medical-coding/cpt.aspx. Published 2021. Accessed December 6, 2021.
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