Navigating Out-of-Network Therapy: Your Guide to Superbills and Reimbursement
Finding the right therapist is a win in itself, but navigating the world of insurance on top of that can feel overwhelming – especially if you discover your therapist is out-of-network. But fear not! Here's where superbills come in as your secret weapon to get reimbursed for out-of-network therapy sessions.
What is a Superbill?
Think of a superbill as an itemized receipt for your therapy session. It includes all the details your insurance company needs to consider reimbursing you for the cost of your out-of-network therapy, usually issued monthly. A superbill includes the following information:
Patient information (your name, date of birth, and address)
Therapist information (name, credentials, NPI number, Tax ID number)
Date of service (session dates)
Cost per session and monthly total
Diagnosis code (based on the ICD-10 system)
Example: F41.1 - Generalized anxiety disorder
Treatment code (based on the CPT code system)
Example: 90834 (95) - this means 45-minute psychotherapy session (over telehealth)
Service description (a brief explanation of the therapy provided)
Example: Psychotherapy, 45 min (10) - the “10” here indicates the patient was at home when they did their therapy session over video
Why Use a Superbill?
But Wait, Will My Insurance Actually Reimburse Me?
Here's the good news: If you have a PPO (Preferred Provider Organization) plan, there's a chance you can get reimbursed for out-of-network therapy – if you submit a superbill. However, the reimbursement rate can vary widely, ranging from 20% to 80% depending on your specific plan. To get that reimbursement, you'll need to submit a superbill along with an out-of-network claim form to your insurance company.
Unlike Kaiser Permanente and HMO (Health Maintenance Organization) plans, PPOs offer more flexibility with out-of-network benefits. To be completely honest, you will likely not get any reimbursement from Kaiser or an HMO.
Submitting Your Superbill
The process for submitting a superbill depends on your insurance company. Generally, you'll have two options:
Claim Form and Mail: Your insurance company might require you to fill out a separate out-of-network claim form and submit it along with your superbill. This can often be done by mail.
Online Portal: Many insurance companies offer online portals where you can securely upload your superbill documents.
So, How Do I Find Out If I'm Covered?
The best course of action is to call your insurance provider and ask! Don't be shy – this is why you pay them the big bucks. Here are some key questions to get the ball rolling:
Does my plan offer out-of-network coverage for mental health services? (You can provide service code 90834).
What is the reimbursement rate for out-of-network therapy per session?
Do I need to hit my deductible before receiving reimbursement?
Is there a limit to the number of sessions/dollar amount you cover?
What is your policy for reimbursing for telehealth vs. in-office visits?
Is there a deadline for submitting claims?
What is the process for submitting claims?
And if you hate the idea of calling your insurance company, keep reading…
Don't Want to Go It Alone? We've Got Your Back!
At Juniper Therapy Center, we understand navigating insurance can be overwhelming. That's why we're proud to partner with Mentaya, a service dedicated to helping you maximize your out-of-network reimbursement.
Mentaya can handle the superbill submission process for you, ensuring everything is filed correctly to increase your chances of a successful claim. For more information on Mentaya's services and fees, visit our policies and fees page.
You can also use this handy online calculator to get a preliminary estimate of your out-of-network benefits.
Remember, this is an estimate based on the information you provide; it’s not a guarantee of how much you’ll get reimbursed.
The best way to know for sure is to call your insurance company.
We know that prioritizing your mental health is an investment of your time, energy, and financial resources. We hope this information makes it easier to understand your options and remove some of the financial barrier to quality therapy – so you can focus on the journey towards healing and well-being.
Please note: This blog post is for general informational purposes only and should not be considered a substitute for professional therapy, which, by the way, we offer! If you’re looking for a therapist, check us out and schedule a consultation today.
