Superbills for out-of-network providers
Health insurance companies separate providers into two categories:
In-network providers have a contract with your insurance company. This means billing the insurance is done by the clinic or clinician, and costs are usually lower for patients.
Out-of-network providers do not have that contract. Some out-of-network providers will still directly bill the insurance company on your behalf, but this is rare because without a contract in place, it is difficult to accurately assess what the cost for the patient will be ahead of time and most clinics want to provide their patients with a cost quote prior to starting services. Aspire Psychology will not bill out-of-network insurance plans directly, which means that in order to use your out-of-network benefits, you would pay the full out of pocket fee at the time of service and then submit documentation (like a superbill) to your insurance company to request reimbursement.
A superbill is a detailed receipt for your mental health services. It contains all the information your insurance company needs to consider your claim and possibly pay you back for part of your costs. A Superbill includes details such as your diagnosis, the billing code the provider chose to best represent the service you received, your contact information, and the amount you paid for the service. Think of it as a bridge between your mental health service provider and your insurance that describes all the information the insurance company would normally receive on a claim sent by your service provider.
A superbill includes the key details your insurance company needs in order to consider reimbursing you for your mental health services. Typically, it contains:
Your information – your full name and date of birth
Your provider’s information – their name, professional license, and a unique ID number (called an NPI)
The purpose of the service – this is shown through a “diagnosis code” which is a number that corresponds with why you were seen, such as anxiety or depression
The type of service – this appears as a “procedure code” that insurance companies use to know what kind of service you had, like an individual therapy session
The dates of your appointments and the fees charged
Proof of payment
You don’t need to know all of these details yourself—your mental health service provider fills them in for you. All you have to do is submit the superbill to your insurance. Many insurance companies allow you to submit claims easily through their portals and apps so that submitting a superbill can be completed in a matter of minutes!
