If you're an out-of-network provider, you need to know when, why, and how to make superbills for your clients. Superbills can subsidize the costs of treatment without you having to panel directly with insurance companies.
In this article, we'll break down:
- whether you should consider superbills for your therapy practice
- what superbills are and what each one needs to contain
- top benefits of using superbills in your practice
- options for creating superbills
- common obstacles clients and providers face with superbills
What is a Superbill for Therapy?
A superbill is a formal receipt that allows clients to get reimbursement from their health insurance company for therapy sessions. Superbills are generated by therapists and given directly to clients.
Therapists aren't the only providers who use superbills. Any healthcare provider who works out-of-network may use superbills as part of their practice. This helps keep services affordable for consumers, but the provider doesn't have to work directly with insurance companies.
Which Therapists Can Provide Superbills?
Therapists can offer superbills if the following circumstances apply:
- they do not accept insurance at all
- they do accept insurance but they are not paneled with a client's particular insurance company
- they are currently awaiting approval to be credentialed with an insurance company
In most cases, superbills are not appropriate when the client is using their in-network benefits. Interns or associates also may not be eligible to provide superbills.
If you are in-network with some insurance companies, you need to review each of their provider policies outlined in your contract. For example, some companies prohibit therapists from charging cash-pay rates to their clients under any circumstances.
Keep in mind that Medicare and Medicaid services may not be eligible for out-of-network benefits. Clients seeking mental health services outside of their insurance company may not receive any monetary insurance benefits.
What Does a Superbill Need to Include?
Each superbill invoice must contain specific information to help clients receive reimbursement. Insurance companies require the following:
Provider Information
- Your name and credentials (i.e. LCSW, LPC, LMFT)
- Your contact information and business address
- Your license number
- Your tax ID or employer identification number (EIN)
- Your national provider identifier (NPI)
Client Information
- Full name
- Date of birth
- Current mailing address
- Diagnosis code
Therapy Session Information
- Dates when therapy sessions occurred (also known as dates services rendered)
- Location of therapy session (i.e. via telehealth or in an office)
- Relevant CPT codes determined by the American Medical Association (AMA)
- The fee charged for each session
- Total charges
Benefits of Superbills for Clients
If you provide out-of-network services, your treatment may be financially inaccessible to potential clients. While this is not inherently problematic, superbills offer a solution to this problem. You retain your full-fee cash rate while clients only have to pay for a portion of the treatment costs.
Reduce out-of-pocket expenses: Superbills lower the cost of therapy for clients. Let's say you charge $150 per session. However, a prospective client has a co-insurance of 40%. Once this client meets their deductible, they are only responsible for paying 40% of her therapy session fee. This means that after receiving eligible reimbursement, she is only responsible for paying $60.
Access to more specialized therapists: Many therapists don't accept insurance. If a client only wants to use their insurance company to pay for treatment, they may be limited in finding the right provider for their needs. This is especially true if they need a particular specialist. Fortunately, most out-of-network providers offer superbills (because it does not impact their compensation), so this opens accessibility to finding more providers.
More autonomy and price transparency: Everyone knows that working with an insurance provider can feel like a financial and logistical nightmare. You never know exactly how much that bill is going to cost! Superbills, on the other hand, provide a concise breakdown of all services rendered. This upfront honesty can promote more autonomy and reinforce the informed consent needed in treatment.
Tips for Generating Superbills
Superbills only take a few minutes to make, and the process is even more simplified if you use an EHR with an embedded superbilling feature.
Manual superbills: Some therapists make their own superbill template by entering each session's information into a document. It's standard to send this information once a month and then update the dates with each new superbill. You can send the superbill via a HIPAA-secure communication platform.
Automatic superbills: Most EHRs have the option to automatically generate superbills. All you need to include is your demographic details and relevant practice information along with the session dates and services rendered.
Outsource to a third party: Some third-party platforms offer support with superbills. They can generate these forms and submit the claim form on behalf of your client. These platforms streamline the process for both clinicians and clients, but they do collect a small fee from the client's reimbursement rate.
How to Support Clients Submit a Superbill
A client submits a superbill directly to their insurance company unless they opt to use a third-party outsourcing system.
In most cases, the client simply logs into their insurance company website, clicks 'submit a claim,' and then uploads their superbill and provides any other requested information. Reimbursement can take up to a few weeks. Other times, a client will need to fax or mail their superbill.
The client is still paying your full cash-pay rate upfront and then filing for reimbursement. The only role the therapist plays is providing documentation. Keep in mind that some clients don't fully understand the difference between using in-network benefits and out-of-network benefits, and it may be helpful to explain this to them.
Setbacks to Using Superbills
Although superbills may seem straightforward, both therapists and clients alike can run into issues when generating and submitting claims.
Clients feel overwhelmed/frustrated by the process: Navigating insurance and learning the ins and outs of out-of-network benefits can be daunting. Some clients will ask for superbills but then fail to submit the claims, leaving them on the hook for out-of-pocket expenses.
Long lag times from insurance companies: Insurance companies aren't always the most communicative, and it's not uncommon for people to wait several weeks or months before hearing back.
Lack of guaranteed reimbursement rates: Insurance companies can deny coverage from an out-of-network therapist, and their reasoning can be incredibly vague or even misleading.
Failing to provide all the right information: Claims may be denied for any reason, including listing the wrong service code, diagnostic codes, or an erroneous appointment date.
High deductibles that need to be met first: Many insurance companies charge high out-of-network deductibles that need to be met before paying out claims. It's important that clients understand this before assuming they will receive reimbursement.
Suberbilling FAQ
When should therapists consider superbills vs accepting insurance?
There's no right or wrong answer. Being part of an insurer's provider panel certainly has its benefits, including more client referrals and potentially less of a need for marketing. At the same time, you may generate less income, and you're at the mercy of what the insurance company wants to pay. You're also susceptible to insurance audits and potential monetary clawbacks.
When do clients need to submit their superbills?
Most insurance companies adhere to 'timely filing limits' that require clients to submit their claim form by a designated date, which can be anywhere from 90-365 days after the services provided.
What if therapists don't want to submit a superbill?
You're never under an obligation to provide a superbill. However, this should be clearly communicated at the onset of therapy, as many clients will ask about ways to subsidize out-of-pocket costs.
Can superbills ever guarantee reimbursement?
No, superbills for therapy are never guaranteed, and insurance claims can be denied.
Do you need to diagnose a client in order to provide them with a superbill?
Yes, most insurers will not cover treatment services without a diagnosis code. It's important to also communicate this with your client, as some people will not feel comfortable being diagnosed or sharing that information with their insurance company.
Streamlining Your Clinical Practice With Superbilling
Whether you're an in or out-of-network provider, Navix Health can support every step of your clinical practice. We are a dedicated team of mental health professionals dedicated to supporting other healthcare providers to grow and maintain their businesses.
We offer several plans based on your needs. Sign up for our free 14-day trial or contact us directly to schedule a custom demo.
