Superbills
A superbill is a detailed receipt you can submit to your insurance provider to seek reimbursement. You pay your therapist directly and are reimbursed a portion by your insurance later
If we work together, you pay me directly for therapy services. Your credit card on file is charged on the day of your scheduled session. If you are hoping to be reimbursed for therapy services, I encourage you to call your insurance directly to inquire about your out of network coverage before beginning services.
Use Reimbursify's Benefit Calculator to determine your reimbursement rates.
(You will be sent a follow up email after you submit your information).
What questions should I ask my insurance?
Call the number on the back of your health insurance card and ask for “member services." Ask these questions to verify out-of-network coverage:
What is my yearly deductible? Has it been met or how much more until my deductible is met?
How many sessions per year does my plan cover?
How much does my insurance plan reimburse for an out-of-network provider for CPT code 90834 (for individual services) or CPT code 90847 (for couple's services)? This is also know as "amount allowed."
What is my co-payment?
Do I need prior authorization?
Do I need approval from my primary care provider?
You can get most of this information via Reimbursify's Benefit Calculator
What can you expect after submitting a superbill?
It can typically take your health insurance 2-4+ weeks to process your superbill. They will either pay the full amount of services minus your copay, or they will put this amount towards your deductible. If your superbill is denied, call your insurance and request information about the denial. I have a membership at Reimbursify that simplifies and speeds up the process for my clients
Use Reimbursify's Benefit Calculator to determine your reimbursement rates.
Current client can submit reimbursement claims here.
How out-of-network reimbursement math works
Details you may or may not want!
1. Determining the "amount allowed" by insurance companies. Insurance companies set a price for what they believe therapy costs. This is generally much lower than the average fees in the Bay Area (and generally) and lower than what would provide cost of living. So if you pay $180 for your therapy and for instance, your United insurance set the price at $100, you will be reimbursed only that $100. The additional $80 will not be reimbursed or calculated as part of your deductible, insurance, or co-pay.
2. Determining your out-of-network deductible. Most people have a deductible--meaning they need to pay a certain amount before insurance kicks in anything. Deductibles exist for out-of-network and in-network benefit. So if you have a $1000 deductible, you have to spend that much out of pocket before insurance pays anything. Submitting Superbills for out-of-network benefits adds to your deductible, but they will only track the "amount allowed" not your actual cost.
3. Determining Co-insurance and Co-Pays. Co-insurance is percentage based and co-pay is a flat fee. So if you have a 20/80 co-insurance from United whose "amount allowed" is $100, you will get reimbursed $80 per session. If you have a co-pay of $10, you will be reimbursed $90.
For example:
Therapist fee: $180
Amount allowed by insurance: $100
20/80 Co-insurance
Amount that counts toward your deductible = $80
Amount your are reimbursed per session after meeting your deductible = $80
Use Reimbursify's Benefit Calculator to determine your reimbursement rates.