Suppose you visit your primary care physician with a sore ankle, and your physician ends up taking an x-ray. When your appointment is finished, someone's gotta pay for that x-ray, right? Now suppose you're insured by United Healthcare. The bulk of the x-ray's cost is paid by your health insurer, UHC, but UHC needs to know what it's paying for. So, either you or your physician has to send UHC a bill. Health insurance companies call this a superbill.
Now for the dictionary definition: A superbill is a document made for insurance companies that details the services a therapist or healthcare provider performed for a client. Essentially, it’s a receipt for your visit to the doctor’s office, but unlike traditional receipts, superbills contain the information needed for insurance companies to pay the claim, like diagnosis and procedure codes.
This means that if your superbills are mishandled or neglected, your claims won’t get paid by your insurance provider. (Some estimates put total client money lost to improperly filed superbills above $50 billion a year! That’s quite the free ride for insurance companies…)
Superbills might look complex at first, but spotting a few essential parts can make them easier to read.
At the very least, your superbill will list your contact info, the date and cost of your service, a diagnosis code, and a procedure code (located under the Service column here).
All superbills contain 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
A superbill can list a single appointment or multiple appointments (that’s what makes them “super”) but any superbill must list both the date and the cost of the service provided. If you don't see these basic items on your superbill, it's not legit, and no medical insurance companies will accept it.
Superbills contain diagnosis codes to classify client symptoms. Like NPI numbers, this is a standard practice used by insurance providers 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, no matter what type of health insurance you have.
The CPT code, which stands for Current Procedural Terminology, is an index of medical and health services created by the American Medical Association. All affiliated physicians of the AMA (read: anyone with the title Doctor) use them. 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.
Ready to submit your superbill?
Superbills can be submitted by a client, by a provider, or by a third party like SuperBill. Navigating insurance companies on your own can be a confusing, difficult process. The very best health insurance companies will remind you to file your claims, but most insurers make it your responsibility to remember to submit superbills and track your claims. Insurers don’t always give you what they owe you, and sometimes they’ll even put up a fight. If you want to save time and energy, let us do the work. Let SuperBill fight for you.