What Is a Superbill?

A superbill is an itemized receipt that contains the information many insurance companies require to process an out-of-network reimbursement claim.

If your insurance plan includes out-of-network mental health benefits, you may be able to receive reimbursement for a portion of the cost of your therapy sessions.

A superbill is not a guarantee of reimbursement. Coverage and reimbursement are determined by your individual insurance plan.

Step 1: Verify Your Benefits

Before beginning therapy, call the Member Services number on the back of your insurance card

You may use the following script:

“I am considering receiving outpatient mental health services from an out-of-network provider. Can you explain my out-of-network mental health benefits?”

Ask the representative:

1. Does my plan include out-of-network outpatient mental health benefits?
2. Do I have an out-of-network deductible?
   A deductible is the amount you must pay before the insurance company begins reimbursing you.
3. How much of my deductible has already been met?
4. What percentage does the plan reimburse after the deductible is met?
5. Is reimbursement based on the therapist’s full fee or the plan’s allowed amount?
   Insurance companies often calculate reimbursement using their own “allowed,” “eligible,” “usual and customary,” or “maximum reimbursable” amount rather than the therapist’s full fee.
6. Does my plan cover the specific service or CPT code being used?
   Common psychotherapy codes may include:90791: Initial diagnostic evaluation
   90834: Psychotherapy, approximately 38–52 minutes
   90837: Psychotherapy, 53 minutes or longer
   90847: Family or couples psychotherapy with the identified client present
   
7. Does my plan require prior authorization, a referral, or a single-case agreement?
8. Are telehealth sessions covered when provided by an out-of-network therapist?
9. How do I submit an out-of-network claim?
   Ask whether claims can be submitted: Through the member website
   Through the insurance company’s mobile app
   By email, fax, or mail
   Through an out-of-network medical claim form
   
10. What is the deadline for submitting a claim?
    This is sometimes called the “timely filing deadline.”
11. Where will reimbursement be sent?
    Confirm whether payment will be sent directly to you or to the therapist.
12. Can you provide me with a reference number for this call?

Write down the representative’s name, the date of the call, and the reference number.

Step 2: Understand Your Benefits

Understanding a few insurance terms can help you know what to expect.

Deductible – The amount you must pay before your insurance begins sharing the cost of covered services.

Coinsurance – The percentage your insurance pays after your deductible has been met.

Allowed Amount – The amount your insurance company considers eligible for reimbursement. This is often different from your therapist's fee.

Example

Therapist Fee: $165

Insurance Allowed Amount: $120

Coinsurance: 70%

Insurance would typically reimburse 70% of $120, not 70% of $165.

Because every insurance plan is different, your reimbursement may vary.

Step 3: Pay for Your Therapy Session

When using out-of-network benefits, you are generally responsible for paying the therapist’s full fee according to the practice’s payment policy.

Your insurance company may reimburse you later if:

• Your plan includes out-of-network benefits
• The service is covered
• You have met any applicable deductible
• The claim is submitted correctly and on time

The practice cannot guarantee that your insurance company will reimburse you.

Step 4: Request Your Superbill

Request a superbill from the practice according to its established process.

Superbills may be provided:

• After each appointment
• Monthly
• Through a secure client portal
• Upon request after payment has been completed

Review the superbill and confirm that your name, dates of service, and payment information appear correct.

Step 5: Complete Your Insurance Company’s Claim Form

Some insurance companies require an additional member medical claim form or out-of-network claim form.

You can usually find this form by:

• Signing into your insurance member portal
• Searching the insurer’s website for “out-of-network claim form”
• Calling Member Services
• Asking your employer’s human resources or benefits department

Complete all sections assigned to the member or patient. Attach the superbill and proof of payment when requested.

Do not change the diagnosis, procedure code, fee, provider information, or other clinical information listed on the superbill.

Step 6: Submit the Claim

Follow your insurance company’s instructions carefully. Depending on the plan, you may be able to upload the claim electronically or submit it by mail.

Before submitting, make sure you have included:

• The completed member claim form, when required
• The superbill
• Proof of payment, when required
• Your insurance member identification number
• Any requested referral or authorization information

Keep a copy of everything you submit.

If mailing the claim, consider using a trackable mailing method.

Step 7: Track Your Claim

Claims may take several weeks to process. Check your insurance portal or contact Member Services to confirm that the claim was received.

Keep records of:

• The date you submitted the claim
• The claim confirmation number
• The date of each therapy session
• The amount you paid
• Copies of your superbills and claim forms
• Any letters or messages from the insurance company

Step 8: Review Your Explanation of Benefits

After the claim is processed, your insurance company should provide an Explanation of Benefits, commonly called an EOB.

An EOB is not a bill. It explains:

• The amount the therapist charged
• The insurance company’s allowed amount
• The amount applied to your deductible
• The amount the insurance company paid
• The amount considered your responsibility
• Whether the claim was denied
• The reason for any denial or reduction

The allowed amount may be lower than the therapist’s actual fee. Your reimbursement is usually based on the allowed amount rather than the amount you paid.

Example

Suppose:

• Your therapist’s fee is $165
• Your insurance company’s allowed amount is $120
• Your plan reimburses 60% after the deductible

The potential reimbursement would generally be calculated using the $120 allowed amount, not the $165 fee.

In this example:

$120 × 60% = $72 potential reimbursement

You would remain responsible for the difference between the therapist’s fee and the insurance reimbursement. Actual calculations vary by plan.

Step 9: Respond to Requests for Additional Information

Your insurance company may request additional information before processing the claim.

Contact the practice if the insurer requests:

• A corrected superbill
• Provider information
• Confirmation of dates or services
• Clinical records
• A treatment summary
• Additional documentation from the therapist

Please provide the practice with a copy of the insurance company’s written request. The practice may require a signed authorization before releasing clinical information.

Some requests may require additional administrative or record-preparation fees when permitted by law and practice policy.

Step 10: Appeal a Denied Claim When Appropriate

A denial does not always mean the service is permanently ineligible. Claims may be denied because of:

• Missing information
• An incorrect submission method
• A filing deadline
• An unmet deductible
• Lack of prior authorization
• Exclusion of out-of-network services
• The therapist’s license type
• The procedure code used
• A request for additional documentation

Call your insurance company and ask:

“Can you explain the specific reason this claim was denied and tell me what is required to correct or appeal it?”

You may have the right to file an internal appeal when you disagree with the insurance company’s decision. Follow the appeal instructions listed on the EOB or denial notice.

Path to Change Counseling is supported by the secure, advanced health records system, Simple Practice. All clients will be required to register with the client portal in order to electronically review and complete forms pertaining to office policies and treatment related consents. 

SimplePractice is designed to be HIPAA-compliant, ensuring that health care providers can manage sensitive patient information securely. Here are some key points regarding its compliance:

1. Data Encryption: All data is encrypted both in transit and at rest to protect client information.
2. Secure Communication: The platform provides secure messaging and telehealth options that comply with HIPAA regulations.
3. Access Controls: Clinicians can manage user access and permissions to safeguard patient data.
4. Audit Trails: SimplePractice maintains logs of user activity to track access to sensitive information.
5. Business Associate Agreement (BAA): SimplePractice offers a BAA to its users, which is a requirement for HIPAA compliance when dealing with protected health information (PHI).

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We understand that life happens, and sometimes you need to cancel or reschedule. We kindly ask that you provide at least 24 hours' notice for cancellations or changes to your appointment. If notice is not given within this time frame, a cancellation fee may apply. Please contact us as soon as possible to make any changes to your scheduled sessions.

Path to Change clinicians are in-network providers for BCBS PPO, Aetna, Cigna, and United Healthcare. Clients can access necessary paperwork (superbills) for insurance reimbursement through their secure client portal on Simple Practice.

Depending on their employer's out-of-network coverage, clients may be reimbursed between 50% and 90% of session fees after meeting their deductible. Before your initial appointment, please contact your insurance provider to inquire about your specific reimbursement rate for outpatient psychotherapy with an out-of-network provider. 

Use the terminology: “Psychotherapy with Patient and/or Family Member” (CPT Code 90837) to get detailed information.

If you have any questions or concerns about our policies or paperwork, feel free to email or call your clinician.

Yes, absolutely! We use a secure online payment system to process invoices. Your payment details are encrypted, ensuring that your financial information is protected at all times. We accept a variety of payment methods, including credit and debit cards, and you will receive a confirmation receipt once your payment is successfully processed.

Protecting your privacy is of utmost importance to us. We follow strict confidentiality guidelines in compliance with HIPAA regulations. All of your personal and therapy-related information is stored securely, and only authorized personnel have access to it. Your information will never be shared without your explicit consent, except as required by law.