How To Use A Superbill for Out of Network Online Therapy
Beginning the process of finding an online therapist can be difficult for some because there are so many out there, and finding the right one can be difficult. The first step may be to go to your insurance provider’s website, or you can also find a therapist on www.Psychologytoday.com to find a therapist that accepts insurance.
Therapists often encourage clients to call their insurance to see what out-of-network benefits they have. If you do find a therapist that you like who is out-of-network, they may provide you a superbill to help you get reimbursed (paid back) for your services.
How Does a Superbill Payment Work?
Typically, a superbill is provided to clients who are working with a therapist who is out-of-network and does not accept their insurance.
If your therapist is out-of-network, this means that they are not connected to insurance panels, or at least the one that you are under. This means, that your therapist will not be submitting to your insurance company for reimbursement. A superbill is your key to getting reimbursement for yourself.
You may want to call your insurance company to see your out-of-network benefits, and ask if you need prior authorization. Medicare recipients do not have out-of-network benefits.
If your insurance company does have benefits for out-of-network providers, you could get partial reimbursement for the money you paid for a therapy service.
How Much Can I Expect to be Reimbursed After I Submit My Superbill?
This is determined by your insurance carrier’s policies and your plan, and there are several factors that can determine how much you may be reimbursed. These factors would include:
The amount allowed for therapy services is based on what your insurance company would pay for an in-network therapist
Your out-of-network benefit level
Whether you met your out-of-network provider deductible for the year
Your coinsurance rate for out-of-network providers (the percentage of charges your insurance company expects you to pay)
In most cases, your insurance company won’t reimburse 100% of what you paid to your provider.
What information is required on a Superbill?
Insurance providers have specific requirements for how they want treatment providers to complete superbills. If any information is missing, the insurer may deny the claim or follow up to get more information before they send payment.
Here are some common items that are typically included on a Superbill:
Client contact information
Provider information
Your diagnosis
CPT code (type of service)
Dates of service
An itemized list of costs
Referrer identification (if applicable)
Your therapist can provide this to you. Some therapists will automatically send this to you at least once a month for you to send to your insurance company. You can also request this on your own from a therapist.
What do you do with your Superbill once it’s filled out?
If your therapist provides you with a completed superbill, you can submit it to your insurance provider. Your insurance provider should give instructions on how to submit your superbill.
Below are some common ways to submit your superbill:
Upload through the insurance company portal (look for a “submit claims” option)
Mail in your completed information
Send a fax
Once your superbill has been accepted, the insurance carrier will send payment. Most of the time, your insurance company will reimburse you directly.
Is there a time limit to submitting my Superbill for reimbursement?
Yes, but it depends on your insurance provider. It is important to check with your insurance carrier for a specific time frame. These guidelines can also be set by state health insurance laws. The time frame can range from 90 days to 1 year.
What happens if my insurance company denies my superbill?
If your insurance company denies your Superbill, first find out why. Your insurance company must explain why this was denied.
There can be many reasons why your Superbill claim was denied. These include:
Missing information on the Superbill
Incorrect billing or diagnosis codes
The claim was submitted outside the time limit
Lack of coverage for submitted services
A determination that the services aren’t medically necessary.
If your Superbill or claim was missing information, you may need to resubmit a corrected claim. Then, your insurance company can reprocess it.
You can also appeal a denied claim. Your insurance company must let you know the process for appealing the decision.
Superbills are a great way to get some money back if you want to see a therapist that you enjoy, but they do not take your insurance. I hope that this was helpful for all of you in making attending therapy easier for you financially!
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Issues with insurance shouldn’t have to get in the way of connecting with the right therapist. If we are the right fit, I’d be happy to support you on your online counseling journey. You can start your therapy journey by reaching out today!
