For Patients

What's a Superbill and How Are They Reimbursed?

An introduction to superbills and how they're paid.

What’s a Superbill?

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 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 are often unaware of their out-of-network benefits. 

Superbills for Insurance Reimbursement

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 healthcare 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 Superbills Are 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 or your Explanation of Benefits 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’s Inside a Superbill? 

A sample superbill.

 

Contact Info

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. 

Diagnosis Code

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.

Procedure Codes

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

How To Submit a Superbill to Insurance Payers

In theory, submitting a superbill to insurance is exactly what it sounds like. What varies in practice is how you submit. Some insurers want you to mail the forms, while others prefer you upload or fax them. Review your plan’s website carefully to make sure you’re submitting your superbills correctly.

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.

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This post was written and researched by
Harry Gatlin

Harry (he/him/his) is a freelance writer and web designer who has worked in the health and tech spaces for over 2 years now. He is passionate about the power of language to make complex systems like health insurance simpler and fairer. He received his BA in English Literature from Williams College and his MFA in Creative Writing from The University of Alabama. In his spare time, he writes fiction and obsesses over Bob Dylan. You can reach him at harrison.gatlin@thesuperbill.com.