What is a Superbill? The complete guide to paying, filing, and creating superbills
June 6, 2023
The Complete Guide to Superbills
A superbill is a crucial tool for out-of-network healthcare billing. If you have ever seen an out-of-network (OON) provider like a therapist, dietitian, or chiropractor, you likely received a superbill. Superbills can be a bit confusing, so we’ve tried to gather all the helpful information we could into one guide.
Whether you’re using superbills as a provider or a patient, this post is chock full of useful tips. For providers, we’ll go over how to create a superbill using our free printable superbill template. For patients, we’ll look at some sample superbills, explain what’s inside a superbill, and cover how to submit superbill to insurance. And of course, we will also answer that one question every OON provider is tired of hearing, “What is a superbill?” At the end there’s even a brief quiz to review what you’ve learned, but don’t worry! We’re not keeping score…
What is a superbill (medical definition)?
A superbill is a document made for insurance companies that details the services a therapist or health care provider performed for a client. Essentially, it’s a receipt for your visit to the doctor’s office, but unlike traditional receipts, superbills contain vital information, like diagnosis and procedure codes, needed for insurance payers to reimburse you for the services after you’ve paid. They're different from regular medical bills in that insurers use them to pay patients rather than providers.
So don’t throw them away!
People often underestimate how much of their superbills are eligible for reimbursement. That’s because superbills deal with out-of-network services, and people often mistakenly assume their insurance doesn’t cover OON care. To check your out-of-network benefits for free and see what kind of reimbursement you might qualify for, try SuperBill’s OON benefits calculator.
What is a superbill for insurance purposes?
Superbills fall under the category of out-of-network billing, meaning they detail services received from a provider who is not within your insurance network. This could be a provider from a different network than yours, or a provider who chooses not to accept insurance at all, which is common among certain specialists like therapists.
Usually, when you see an out-of-network provider, you pay them out of pocket for their services. Then, they provide you with a superbill detailing those services and their costs. To get your superbills reimbursed, you or your provider has to file an out-of-network claim with your insurer. Your insurer will review the claim and reimburse all, some, or none of the services depending on their assessment. In the event that not all of the claim is reimbursed, you then have the option of fixing the rejected parts and refiling the claim.
As we often say, the process may be tedious, but it's worth it. Fixing your rejected claims can save you hundreds if not thousands of dollars a year. For more information about how out-of-network reimbursement works, read our Complete Guide to Out-of-Network Reimbursement.
Pro Tip: Be resilient when filing for out-of-network reimbursement. Insurers often reject claims for very minor errors that, when corrected and refiled a few times, could save you a lot of money.
Why do therapists use superbills?
The process of joining an insurance company's network can be long and tedious. Specialists like therapists have to get on a provider panel which requires an extensive series of applications and interviews.
Superbills let therapists and other medical specialists provide care and get paid without being on a provider panel. They’re a neat tool for bypassing the bureaucratic hoopla and connecting providers with patients. Let’s just make sure we’re using our superbills correctly…
Why are superbills important?
Think of it this way: your superbills are the keys that unlock your insurance reimbursements. If your superbills are mishandled or neglected, you won’t get paid back by your insurance payer. (Estimates put total annual money lost by patients to improperly filed superbills over $50 billion!)
Check your plan’s website to see what percentage of out-of-network services your insurer has agreed to cover through coinsurance. Once you’ve met your OON deductible, your OON benefits might include up to an 80% reimbursement!
People leave this money on the table all the time, because they simply don’t realize how many OON services are covered by their insurance plan. We really don’t want that to happen to you, so let’s go over what’s inside a sample superbill.
What does a superbill look like?
Superbills may look different depending on your provider, so interpret this superbill example loosely. Regardless of who issues it though, every superbill will contain the following pieces of information.
Essential client info like name, date of birth, address, and phone number. Superbills also list the practitioner’s information, including the name of the practice, office location, and National Provider Identifier, or NPI number. An NPI number is a unique identification number for healthcare providers. It has been adopted as the standard provider identifier, as most healthcare providers are issued one.
Date and Cost of Service
Superbills include the date and cost of the service provided. A superbill can contain a single appointment or many appointments (that’s what makes them super!) but any superbill must list both the date and the cost of each one.
Superbills contain diagnosis codes to classify client symptoms. Like NPI numbers, this is a standard practice insurance providers use for identification and billing purposes. Currently, providers use the International Statistical Classification of Disease and Related Health Problems, which is known as the ICD10. However, some providers still use the outdated system, ICD09 to code. If the ICD09 system is used, your insurance will reject the claim.
The CPT code, which stands for Current Procedural Terminology, is an index of medical and health services created by the American Medical Association. CPT codes are used to describe the types of services rendered to a client. For example, there are different CPT codes for intake interviews, individual psychotherapy (45 minutes) and individual psychotherapy (60 minutes). Here is a full list of CPT codes for psychology services.
For Patients: How to submit superbills to insurance payers
We don’t recommend for patients to submit superbills to insurers themselves. Why? Because it’s easier and more cost-effective to let SuperBill file your claims. But if you do decide to fly solo, we still want to help guide you. Here are a few things to consider when thinking about how to send a superbill to insurance payers.
- Understand your benefits.
Before you file your own out-of-network claim, it’s important to understand your OON benefits. Usually, the easiest way to do this is by viewing your plan details on your insurer’s website. Or, you can call your insurance company using the number on the back of your health insurance card.
Questions you may want to explore include:
- Do you have out-of-network benefits? If so, what is your out-of-network deductible?
- Have you met your deductible?
- Does your insurance plan cover the specific services you received? Some plans have exclusions to what is covered.
- What is your coinsurance rate, or the portion of the bill that is your responsibility?
- What percentage does your insurer cover? This is the amount you may be reimbursed.
Pro Tip: If you want to save time, use SuperBill’s FREE benefits calculator!
- Review the submission instructions on your insurer’s website.
In theory, sending a superbill to insurance is exactly what it sounds like, but because insurers hate making things easy for patients, submission protocols differ from one insurance company to another. Sometimes it’s as simple as uploading a claim, but some companies want you to fax or mail them. Review your plan’s website carefully to make sure you know how to send a superbill to insurance.
Pro Tip: If you are set on filing your own claims, SuperBill’s medical claims forms database is a good place to start. It has links to claims forms for every major insurance company!
- Double-check your personal information.
Review the information you input on the claim form, especially your insurance ID numbers. More claims get rejected due to simple data errors than you might think.
- Review the CPT and ICD codes in your superbill.
To be extra thorough, you can double-check the medical coding in your superbill. Hopefully you have been successful getting a reimbursement for your superbills for the same type of services in the past. If so, compare your current superbill with past ones. Ask your provider if you notice discrepancies or missing codes. Medical coding mistakes are one of the most common reasons insurers reject superbill claims.
On a similar note, if you are a provider or medical coder looking to brush up on your coding skills, give this post on CPT and ICD-10 Coding Tips a look.
- Prepare to refile.
Even if you handle all of the above steps with care, it’s still possible your insurer will reject your claim. After all, insurance companies have an army of employees whose sole job is to save the company money. But rejection is not the end of the line! You can correct and refile your claims. In fact, you should refile if you think you’re entitled to the reimbursement.
Who Can Submit Superbills?
Superbills can be submitted by a client, a provider, or a third party like SuperBill. At SuperBill, our mission is to simplify the out-of-network reimbursement process for patients. All you have to do is upload your superbills to our site, and we’ll take care of the rest.
Navigating insurance companies on your own can be a confusing, difficult process. Insurance companies make it your responsibility to remember to submit superbills and track your claims. They don’t always remind you or give you what you’re owed. If you want to save time, energy, and money, let SuperBill fight for you. Just enter your email and click Get Started.
Quick FAQs and common misconceptions about superbills
Superbills are not really bills.
The name superbill is a little misleading. Superbills are more like itemized receipts, issued after a service is paid for. They list the names and costs of your health expenses. But be careful: don’t throw your superbills away with your other receipts! You will need your superbills to file out-of-network health insurance claims.
Well then, what are superbills?
In literal terms, a superbill is a document an out-of-network provider gives a patient after they’ve paid for services. Sometimes they are called “encounter forms”. A superbill for insurance shows the provider’s ID, the patient’s diagnosis, and service(s) rendered. It also records their cost, the amount paid, and the patient’s name and address.
For another analogy, think of superbills as a vehicle. Superbills transport medical data from a doctor’s office to an insurance company. The data is written in a universal language of medical codes, so that both the provider and insurer are on the same page. These codes, called ICD and CPT codes, are essential knowledge for any out-of-network provider’s billing specialist.
When are superbills used over regular bills?
When a healthcare provider or facility is in-network, it means they accept your insurance. The provider files an insurance claim and the insurer pays the provider directly. This isn’t the case for out-of-network services.
When a provider is out-of-network, they don't accept your insurance. The patient pays for the services up front. The patient needs detailed information to submit information to their insurance to file a claim. The insurer then reimburses the patient, not the provider.
Out-of-network providers record the services they provide and the patient’s payment into a superbill. This helps the patient submit a claim and get reimbursed. Again, the insurer can only reimburse a patient for services they have already paid for. Learn more in our Complete Guide to Out-of-Network Reimbursement.
Which specialists typically issue superbills?
Many types of healthcare providers use superbills for at least part of their practice. These include but are not limited to:
- Clinical social workers
- Psychologists and psychiatrists
- Speech language pathologists
- Lab testing clinics
- Pain management clinics
- Plastic surgeons
- Optometrists and ophthalmologists
- Family physicians
- Lactation specialists
- Fertility clinics
- Physical therapists
- Occupational therapists
- Massage therapists
- Physicians and physician assistants
- Nurse practitioners
The most common OON providers issuing superbills are therapists. SuperBill works with plenty of mental health practitioners, so we are no strangers to therapy reimbursement. If you are a therapist, you might be interested in our post on how to make a superbill for therapy clients.
What is SuperBill, the company?
We’re so glad you asked! SuperBill is a company that makes out-of-network reimbursements easy. We work with both patients and providers to get you the maximum allowed reimbursement from your insurance. Just upload your superbills to SuperBill's portal, and we’ll file and track your claims.
Insurance claim rejections are increasingly common. The good news is, after we submit claims to your insurance for reimbursement, we’ll correct and refile them if they’re rejected. We fight tooth and nail to negotiate the best possible reimbursement. We also offer benefits checks, claim tracking, and support from insurance experts.
How do I submit superbills with SuperBill?
All you have to do is upload your superbills to our online portal, and we’ll take care of the rest. Patients can upload their own superbills, or providers can upload them on their patients’ behalf.
After you create an account, you can visit the online portal to track the status of your claims, check your benefits, and view your reimbursements.
What is SuperPay?
An even easier way to get your out-of-network claims reimbursed! With SuperPay, you get full access to SuperBill’s claims-filing services FOR FREE. All you have to do is link a bank account and pay your superbills with SuperPay. As soon as the bill is paid, we file a claim with your insurance on your behalf.
The bills cost you exactly the same, and you get them reimbursed automatically. It’s even easier than we described in the last FAQ. With SuperPay, you don’t even have to upload your superbills.
Refer your provider to SuperPay and you can get up to $100 when they join!
For Providers: How to create a superbill + a free superbill template
If you are an out-of-network provider, your patients can benefit from receiving a superbill for your services. If you use EHR software for your practice, it can most likely generate superbills for your patients automatically. If this is the case, use that feature! If not, see our superbill template below.
The Importance of Accuracy in SuperBills
The main point probably goes without saying: double-check your medical coding. Your patients reimbursement claims can be denied if there are errors in your coding. ICD-11 is on its way, but it still hasn’t been phased in completely. ICD-9 is out and will not be accepted by insurers. Instead, prepare your superbills using ICD-10 codes. Review ICD-10 codes and CPT codes carefully to make sure they’re free of errors. If you want to go deeper on this subject, read our CPT and ICD-10 Coding Tips.
If you are a provider who does not have a system that automatically generates superbills, don’t fret. With a little effort, you can create your own superbills. To make this easier, download and customize our free printable superbill template.
Review: Test Your Superbill Knowledge
Time to see how well you were paying attention! The answers are at the bottom of the page.
Which of the following is not found on a superbill?
A) ICD-10 Codes
B) Patient’s Name and Address
C) CPT Codes
D) Patient’s Medical History
Where do you find information about how to submit a superbill to your insurance?
A) Your EOB
B) Your Insurer’s Website
C) The Bottom of Your Superbill
D) Ask Jeeves
SuperBill handles ____________.
A) Negotiations with Insurers
B) Verifications of Benefits
C) Out-of-Network Reimbursements
D) All of the Above
We hope this post clarifies how superbills work. If you’d like to know more, we also have a more in-depth Intro to SuperPay than we had time to give in the FAQs, as well as several other resources on the SuperBill Blog.
Are you ready to simplify your out-of-networks claims? Let us take a load off your shoulders. Sign up and let SuperBill save you time and money today!
Test Answer Key: D, B, D