Key takeaways: If you’re new to the world of private pay, you might be unsure of how the whole process works. Here, I break down:
What is a superbill? This mysterious term intimidates both therapists and clients alike. The good news is that a superbill is a very simple document which almost anyone can create. In this article we will break down what a superbill is, how it works, why it's important and how you can make one.
Many people put off looking into superbills because they dread having to deal with their insurance company. If you are reading this, congratulations! You have already taken the first step!
While superbills are used by a wide variety of healthcare providers, this article will focus on superbills for therapists (also referred to as "behavioral health providers" or an "out-of-network providers")
You may have heard of superbills from friends who have worked with a medical healthcare provider that is out of network, such as specialist or a physical therapist, for example. People use them when seeking reimbursement from their insurance company. Here, we'll be discussing what a superbill is for therapy (aka mental health services).
So, what is a superbill? It is essentially a receipt that allows patients to get reimbursed for therapy. A superbill is typically a PDF or one-page receipt that a provider (or therapist) generates for clients. Insurance companies require it from patients in order to get reimbursed for services using their insurance benefits. A superbill includes specific pieces of information, such as when a therapy session occurred and the patient's diagnosis code (more on this below).
For many therapy clients, superbills are the only way to make therapy affordable, especially since most therapists do not take insurance (in other words, their therapy is considered "out-of-network services"). In such instances, a client's only recourse is to utilize what's known as "out of network benefits," offered by their insurance provider, ensuring that they can maximize their insurance claims to offset the costs of therapy.
A superbill is a detailed invoice that must contain specific information. In order for an insurance company to accept a superbill for reimbursement, they must have the following information:
Therapist Information (aka provider's information):
Patient Information:
Session information:
Note: In most cases a given patient's superbills will repeat the exact same information in all their superbills with just the session date changing
But what are the benefits for clients? In this section, we will discuss the ways in which superbills can help therapy clients access affordable and quality mental health as well as how therapists can benefit from issuing superbills.
Retain More Clients:
Finances are cited as a leading reason for clients reducing therapy frequency or terminating therapy altogether. By providing clients with superbills, therapists equip clients with the key to unlock their insurance company's behavioral health benefits. The client submits their superbills with their insurance company following a therapy session (aka "patient visit).
It's important to note that for some this process can be fairly straightforward, while for others (especially neurodivergent clients) managing the superbill submission and follow-up can feel like a lot. The good news is there are companies such as Mentaya that can take care of submitting superbills for clients reimbursed without involving therapists. See the "get the support you need" section below to learn more.
Reduced Out-of-Pocket Costs
Superbills can help clients to reduce their out-of-pocket costs for therapy. The majority of insurance plans have "out-of-network-benefits" which means that a client can receive reimbursement on 50-80% of your fee. So for example, if you charge $200 per session and your client Sally has a co-insurance of 30%, this means Sally is only responsible for paying for 30% of the session costs (once she meets her deductible). In other words, Sally could receive reimbursement of $140 per session from her insurance company (without involving you as the therapist!). Even if a client's insurance plan does not fully cover out-of-network mental health services, they may still be able to receive some reimbursement.
Clients are very limited in their choice of therapists if constrained to therapists who accept insurance. Less than 30% of therapists on psychology today do! As a result, clients may spend months or even more than a year on waitlists waiting to be seen by a therapist.
Superbills expand the options for clients to almost any therapist who is taking new clients. This is because any therapist can easily offer a superbill for insurance regardless of if they accept insurance. Providing a superbill does not affect a therapists compensation in any way and there are many options that automatically generate superbills without requiring any time on the therapist's side (see more in "how to generate a superbill" section below).
Greater Transparency and Control
Superbills give clients a clear and concise breakdown of the services they have received and the associated costs. This transparency allows clients to make informed decisions about their care and to track their progress over time.
There are several ways to generate a superbill:
You can create your own superbill by manually entering the information from your sessions into a superbill template. You can use this free superbill example (just select "file" --> "make a copy" and then editing directly on the form. See page two as an example). Typically therapists send superbills once a month and it takes 2-5 minutes for each client. Once you have created a superbill for a client the only information you typically need to update each month is the session dates. You then provide superbills to your client and they use it to submit a claim with their insurance company.
Some EHRs such as Simple Practice will automatically generate super bills for your clients at a regular cadence. Many therapists configure their EHR to upload the superbill at the end of the month for each client. Your client can then download a PDF of the superbill and use it to submit their claims with their insurance. The insurer pays the client directly for a portion of the therapy.
You can outsource the entire superbill & claims process by partnering with a third party platform like Mentaya. Not only do they generate the superbill, they will submit claims for your client. As the therapist you collect payment in full from you client upfront and Mentaya will handle getting your client reimbursed (without involving the therapist!).
Although generating a superbill for insurance is extremely simple for therapists, there are many challenges when it comes to clients successfully using superbills:
Therapists: if you're looking into how to make a superbill you're likely someone who cares about making therapy more accessible for your clients but you don't want to take on the burden yourself (and rightfully so!). You want to help your clients help themselves.
While providing a superbill for a client is a solid start, there are so many better resources you can connect them with that will empower them to get reimbursed for therapy without involving you or costing you any money.
There are several companies in the "third party billing" space who will automatically file claims for clients after every session. They vary in pricing, but options exist that are completely free for therapists. For example Mentaya has an automatic claim submission service that is free for therapists and only charges a 5% fee for clients.
Services like Mentaya's will not only automatically submit and track claims on behalf of clients, they also have a support team with insurance pros who you can direct clients to if they have any questions. Mentaya seeks to completely remove the therapist from the insurance process; however they do allow therapists to see their clients' claim status on their online portal should they be interested. The concierge support team will go to bat for your clients: tracking claims, troubleshooting and resubmitting if needed.
Mentaya boasts that 62% of clients' therapy costs are reimbursed on average (once they meet their deductible) and offers a risk-free guarantee that claims will be successfully processed (or your client is fully refunded).
Can clients with medicare or medicaid make use of superbills to get reimbursed for therapy? Typically medicare or medicaid services are not eligible for out of network benefits and clients must pay out of pocket fully.
Do clients need to have to have prior authorization in order to submit a superbill for insurance reimbursement from their insurance company? No! Clients do not need prior authorization.
Why aren't more therapists accepting insurance? There are several reasons therapist choose not to take insurance including:
1. Getting on insurance panels and submitting required documentation requires significant time which therapists are not compensated for.
2. If you're on provider panel there are often limits on what services a you can bill for as a therapist.
3. Accepting insurance limits therapists's ability to set their own rates for services rendered. They are at the whim of insurance companies who non-transparently set limitations on how much a therapists can be reimbursed (using stipulations such as "allowed amounts").
Can superbills be used for in-network claims ? For in-network providers, the billing process is usually handled directly between the provider and the insurance company. The provider submits a claim to the insurance company after the services are rendered.
Do clients have a deadline for submitting superbills to their insurance company? Yes, most insurance companies that offer out-of-network coverage have what's called a "timely filling limit". That means each insurance plan stipulates that clients must submit their insurance claim by a certain number of days after their therapy session occurred. Timely filing limits vary widely but typically range from 90-365 days.
Do clients submitting superbills for medical and health services also have a deadline for submitting superbills to their insurance company? Yes! Healthcare claims also have "timely filing limits". If your clients are planning to submit a healthcare claim they should check their insurance company's guidelines. This information can typically be found in the terms and conditions of their insurance policy. The time limit for filing a claim may range from a few months to a year after the date of service.
How can clients get superbills? Simply ask your therapist! Most therapists are happy to provide superbills. It is quick and easy for them.
All About Superbills: A Guide for Mental and Behavioral Health Providers
Insurance Coverage and Mental Health Services
Mental health parity
