Here at Riverbank Therapy, we provide courtesy billing for clients who want to use their in or out of network insurance benefits (read more about this below, and more about our fees and billing practices here). However, many therapists in the field opt to provide clients with superbills rather than doing courtesy billing.

Even if you don’t seek therapy at Riverbank, we’d love to support you in understanding what a superbill is, how they work, and what out of network reimbursement can look like with superbills. We want to support you in feeling confident navigating the financial side of therapy services.

What is a superbill?

A superbill is a receipt from your therapist provided to you after a session has occurred. You can submit your superbill to your insurance carrier for potential out of network reimbursement.

For successful claims processing with your insurance, the superbill must contain at least:

your name, date of birth, and insurance ID number,
the date of service for the session,
the CPT code for the session (for most therapy sessions this is 90791, 90837, or 90834), including any modifiers for the session if it was a telehealth session,
your diagnosis (yes, even with out of network billing, you must have a diagnosis on the superbill for insurance reimbursement),
the providers name, license number, NPI number, and tax ID number,
the fee for the session, and how much you paid.

Some insurers may require more information on a superbill, but this is typically what is required.

Why is my therapist giving me a superbill?

Therapists who are out of network with insurance companies may choose to provide you with a superbill rather than doing courtesy billing (more on courtesy billing below).

Therapists often choose to do superbills because they do not have to navigate the complexities of insurance systems and incur less risk financially. With superbills, the therapist collects the full session fee from you up front, and then you do the legwork to potentially get reimbursed by your insurance company.

What if I don’t HAve or want a mental health diagnosis?

We understand that not everyone wants to have a diagnosis in their medical record. Much of what brings us to therapy is just a result of being a human, and labeling your experience with a diagnosis is not always helpful.

However, a diagnosis is required for in-network and out of network billing for services to be reimbursed by your insurance company. Sessions will not be covered by insurance without one. Unfortunately, this is how the insurance industry in the United States functions, regardless of how your provider handles billing.

If you don’t want to have a diagnosis on file, you will want to opt for “private pay”. This is effectively just paying out of pocket for therapy sessions and not involving insurance at all.

How do I submit a superbill?

Different insurers have different processes for submitting superbills. Most of them have an online member portal where you can fill out a claims form requesting reimbursement and include the superbill (with all of the information listed above, and anything additional your insurance carrier requires). Then you wait for them to process the claim and determine how much was covered by your insurance.

Some HSAs also require you to submit a superbill when using HSA funds to pay for therapy sessions. Check with your specific insurance plan and HSA to find out what is required.

How much will my out of network insurance cover when I submit a superbill?

This depends on your plan. See more on our Insurance 101 page for information about insurance plans, deductibles, coinsurances, and the difference between in and out of network providers.

When you submit a superbill, you’re doing it because your therapist is out of network with your plan. Your therapist should quote you an estimate of your benefits before your first session so that you have informed consent about what therapy will cost for you. Not all providers do this though, so we recommend also calling your insurance carrier to find out what your out of network coverage is.

Most out of network plans have a deductible that you have to hit before insurance begins covering anything. For example, you may have a $3000 out of network deductible. This means you have to use $3000 worth of medical services before insurance will pay anything. (More on this on our Insurance 101 page). Once you hit your deductible, most plans have an out of network coinsurance. For example, after paying $150 per therapy session until you hit the $3000 deductible, you might then have a 50% coinsurance per session. This means you would pay $75 per session, and your insurance would reimburse you for the other $75.

However, if your provider is doing superbills, you would have to pay their $150 fee up front, even after you’ve met your deductible, then submit the superbill to your insurance, and wait for your insurance to reimburse you for the $75 (50% coinsurance) that they cover.

Again, we recommend reaching out to your specific insurance carrier to find out what your out of network coverage is.

How do I get reimbursed by my insurance company?

Most insurance companies mail you a check for the covered amount after you submit the superbill and they process the claim. This typically takes around 30 days after you submit the superbill.

What is courtesy billing?

Courtesy billing means that you don’t have to deal with superbills! Courtesy billing means that your provider submits claims to your insurance on your behalf, and then the provider waits for reimbursement.

For our above example, with a superbill, after you met your deductible, you would have to keep paying your therapist $150 out of pocket each session, then wait for your insurance to reimburse you for the $75 covered after your submit the superbill.

With courtesy billing, once you’ve met your deductible in the above example, you would just pay the 50% coinsurance ($75) up front to your therapist, and then your therapist would wait for insurance reimbursement instead.

We do courtesy billing at Riverbank Therapy. We find it to be easier for our clients and increases the accessibility of therapy. More information on how we handle this on here.

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WANT TO HEAR MORE ON THIS TOPIC? LISTEN TO TONI TALKS THERAPY EPISODE 2 ABOUT STARTING THERAPY!

Does insurance make you want to tear your hair out? When you hear about copays, deductibles, coinsurance--do you want to bolt and run?

I hear ya. That used to be me. Then I started interacting with insurance as a provider, and now I believe it's so empowering for you to understand clearly. When you know what your coverage is and what you will owe for services, you're way more likely to actually get the help you need! I'm all about that.

So here we go. Insurance 101.

You have a PREMIUM. This is what you (or your employer, or a combination of both) pays each month to your insurance company for your plan. Pretty simple. This premium collected by your insurance carrier is how they cover costs for any claims they have to pay out for all of their members.

Unless you have the world's best insurance, you will have a COPAY or COINSURANCE for services. A COPAY is a set rate that you pay (like $20) for services, no matter what the provider's rate is--your insurance covers the rest. COINSURANCE, is a percentage of the provider's fee that you pay (like 20%) and then your insurance pays the rest (80%).

Depending on your plan, you might *only* have to pay a copay or coinsurance for services. Lucky you! However, more and more plans lately have a DEDUCTIBLE. This is an amount your insurance plan sets that you have to pay out of pocket before they cover anything. (Usually, the deductible does not apply to preventative care like your yearly wellness check and sometimes for mental health services like therapy, but check your specific plan for details.) This means you'll pay 100% of the provider's fee until you've paid as much as your deductible, and THEN your copay or coinsurance rates apply.

Example: You have a $1500 deductible that applies to therapy services. After your deductible, your insurance pays for 60% of the providers fee, and you have a 40% coinsurance. Your therapist's rate is $120 a session. You pay the full amount for 12 sessions, and at that point you’ve paid up to your deductible amount of $1500. (A note here: insurance companies don't actually care how quickly you pay your provider, so you can work out a payment plan for this part! Your deductible will still be counted as “met” by your insurance even if you haven’t actually paid that total amount to your provider. Feel free to ask your provider if they offer payment plans for situations like this--most will. I do this all the time for our clients!) Once you’ve met the deductible, then your coinsurance kicks in, and you only owe 40% each session, or $48. Yay! That happens until the plan year resets and you start the deductible over again.

Typically, you will have different coverage for an IN NETWORK provider than an OUT OF NETWORK provider. Insurance companies have a panel of providers that they contract with. When providers contract with insurance, they agree that the insurance carrier can adjust the provider's rates. This insurance-determined rate is called a “contracted rate” or “reimbursement rate”.

Because in-network contracts mean lower reimbursement rates, your out of pocket cost will be slightly lower when you see an in-network provider (also because your in-network benefits typically cover more than your out of network benefits do). Many therapists choose to be out of network because these in-network reimbursement rates are low, rates are not raised often, and insurance companies don’t really negotiate their rates.

Another issue with in-network billing (as well as out of network billing) requires that your provider give you a diagnosis. In addition, when using your in-network benefits, your insurance company has control over how often and how long you see your provider, as well as the approach your provider takes in therapy.

Out of network providers do not have a contract with your insurance company, so their rate will not be adjusted down*, but the services might still be covered by your plan at some level. Typically, with out of network benefits, there's a deductible and then some level of coinsurance. Again, it varies from plan to plan, and also depends on the provider. Out of network services also require a diagnosis, but your insurance company has less control over the therapy process.

Some therapists opt to provide you with superbills for out of network therapy. At Riverbank Therapy, we do courtesy billing because we find it is easier on you as the client. Read more about superbills and courtesy billing here.

*some plans are now implementing an “allowed amount” with out of network providers. This means that if your session fee is $150, the insurance carrier may only apply part of that fee (the “allowed amount”) to your deductible, and you’re still responsible for the rest of the session fee. This means it can take a bit longer for you to meet your deductible. Again, check your specific plan or talk with our admin team to find out if your out of network benefits include an allowed amount for sessions or not.