What you need to know to potentially get reimbursed from your insurance company for out-of-network therapy services.

You may have noticed that many psychotherapists, especially those who do not take insurance for payment offer superbills for potential reimbursement. If you are wondering what that actually means, hopefully this article will help answer some of your questions.
*Disclaimer: I am not an insurance specialist, so please take this information as a general guideline and contact your insurance company for more information regarding your individual benefits.
What is a superbill?
A superbill is a receipt or invoice for services. It includes such information as my practice information, NPI number, and Tax ID. It also includes your information – name, address, date of birth, and a diagnosis and code (it is required to have a diagnosis in order to receive reimbursement for therapy services). The service type, date, and required code will also be listed on the superbill. Finally, the fee you paid for services is also included on the superbill.
How I use superbills in my practice:
Unless you have Cigna - Evernorth insurance, which I was just paneled with in January 2024 - you may want to consider submitting a superbill for sessions with me.
After each of our sessions, the card you have on file with me will be charged for services. If you would like to potentially receive reimbursement from your insurance company, I am happy to provide a superbill. A superbill includes the information your insurance company should need in order to provide any potential reimbursement that your plan outlines for out of network therapy benefits. I generally provide superbills once per month via email.
It is recommended that you check with your insurance company regarding possible reimbursement before beginning therapy if receiving reimbursement is something you would like to pursue. Here are some important questions to ask:
Do I have out of network coverage for mental health services, in person and over telehealth?
What is my yearly deductible and has it been met?
How much reimbursement does my insurance plan provide for out of network therapy, specifically CPT codes 90834 and 90837?
Is there a limit to how many sessions my plan will cover per year? What is the limit if so?
Do I need prior authorization or approval from my primary care provider? If so, how do I obtain authorization?
Does my plan cover couples therapy? (if applies)
How do I submit a superbill? Is there an online portal where I can do this, and if not, where do I mail or fax a copy?
What is the time limit for submitting a superbill?
Some things to consider:
Insurance companies do require a diagnosis for reimbursement. The diagnosis must be listed in the DSM-5-TR, the Diagnostic and Statistical Manual of Mental Disorders. I am happy to discuss your diagnosis, and any concerns that you have regarding receiving a diagnosis at any time.
Insurance often does not reimburse for couples therapy, which is why I recommend you ask about this when contacting your insurance company.
Approximate Reimbursement timelines:
If you are wondering how long it can take to get reimbursement, of course all plans and companies are different, but from what I have experienced, it generally takes two to four weeks to process superbills. Also, keep in mind that insurance companies often have time limits in which you can submit, so submit often!
I hope this helps! Please reach out with any additional questions.
Cheers, D.
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