What are Superbills?
Superbills 101
What are superbills
Definition: a receipt of medical services written in a coded form for the purposes of reimbursing out-of-pocket payments to said medical service provider. The rate of reimbursement for these services depends on your insurance plan. They may pay a similar amount compared to the coverage of services for an in-network provider or they may be less, the only way to know how this works is by following up with your insurance provider (described below).
Use: to reduce the financial burden of medical services for a client when a provider is out-of-network, therefore making medical services more accessible
Does my insurance reimburse superbills?
Reimbursing superbills is a common way of paying for out-of-network services, but your insurance company may or may not utilize them.
To find out more, start by reviewing your insurance documentation, there may be a section that discussions out-of-network services (which may include superbills). If your documents don’t provide a sufficient answer, you may want to reach out to your insurer directly.
They may be able to give you clarity on if they work with superbills or not, but they likely will need more information from you prior to giving you an estimate of what amount they reimburse.
Information your insurer may ask about:
They may ask for an NPI (National Provider Identifier) number, which is a number associated with each individual provider that clarifies what type of provider they are (Taxonomy Code), among other things beyond the scope of this post. They may also ask simply for the relevant taxonomy code rather than the more specific NPI. For example my taxonomy code is: 103T00000X (Clinical Psychology). This is a short hand way to speak to the education and experience level of an individual clinical, which insurance takes into account when determining reimbursement rates and fee schedules.
They may ask about the location the services were provided. For my clients, this will be a code that indicates where you are located during your teletherapy sessions (also know as POS or Point of Sale/Place of Service): either at your home (10) or at a place other than your home (02).
They may ask you what diagnosis code is being used. If you are a current client of mine or have worked with another mental health professional who gave you a diagnosis, I can provide you with a code specific to you and your diagnosis. This code is called an ICD code and it communicates some generic information about what you are working on in therapy. It can be a singular code to represent your primary diagnosis or it can be a number of codes, each corresponding with a diagnosis that you have received and that therapy is address.
They may also ask for a service code which indicates the type and duration of a service. If you are a client of mine, this will typically be 90837, if you are an individual therapy client or 90847 if you are a couple or family therapy client. These numbers are both associated with a session length of 53 minutes.
If there are additional questions asked which are not covered by this post, feel free to reach out to me directly and I can provide additional information!
Other things to consider
Timeline for reimbursement
When an insurer confirms that they reimbursement superbills at a rate enables you to receive relevant services from your provider, you would attend your appointment and pay the bill out-of-pocket (private pay), then your medical professional would provide the superbill to you, which you would then pass along to your insurance company.
Note: when utilizing superbills, it is your responsibility to get the payment reimbursed by your insurer, not the responsibility of your medical provider.
This process is not automatic, it can take on average between 2-4 weeks to be reimbursed. The initial reimbursement may take a bit longer, especially if there are any errors which need to be corrected.
Errors and Corrections
If there is an error of your superbill, it will need to be corrected before reimbursement will be sent your way. If this happens, you would need to inform your provider so that they can correct the superbill before you send it back to your insurance provider.
TLDR: Superbills are a form on insurance reimbursement for out-of-network providers who do not accept your insurance. If you are hoping to work with a private pay therapist, superbills are one option to reduce the financial burden on the patient, available at the discretion of the therapist/organization.
Important Disclaimers
Not all insurance providers utilize superbills and not all therapists offer them
Rate of reimbursement is variable (depending on your insurance plan, length of session, qualifications of your provider, etc.)
Reimbursement is not automatic and it can take a few weeks to receive
This is a general description of superbills and the process of out-of-network reimbursement. For more detailed and relevant information, contact your service provider.
