How Super Bills Work

Use a Super bill to request reimbursement from your insurance company for therapy sessions you paid for out of pocket.

At this time, I don’t accept any insurance. This means clients need to pay out of pocket and I am an “out of network provider” with your insurance. Reimbursement is not guaranteed unless specifically outlined in your policy, but you can submit a “super bill” to your insurance for possible partial reimbursement.

What is a super bill? 

A super bill is a document, like an invoice or receipt, that outlines the services you received with your therapist. It is generated by our electronic health system and sent to you automatically on a monthly basis. It must include the following information in order to be considered for reimbursement: 

  • Client name, address, and date of birth 

  • Therapist name, phone number, and email

  • Therapist Tax ID and National Provider Identifier (NPI)

  • Statement number and date issued to client 

  • A diagnosis and diagnosis code (also called a CPT code) 

  • Service type, date, and code for reimbursement 

  • The fees that you paid 

Some things to consider before deciding to submit a super bill to insurance:

Reimbursement requires a diagnosis - a super bill, just like any other paperwork submitted to insurance for reimbursement, requires a clinical diagnosis as classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) and the International Classification of Diseases (ICD-10). Examples of diagnoses and their codes can include: 

  • Adjustment disorder, With depressed mood (F43.21)

  • Bipolar I disorder, Current or most recent episode depressed, In partial remission (F31.75)

  • Posttraumatic stress disorder (F43.10)

  • Etc.

If you have continuing questions about your diagnosis or have concerns about receiving a diagnosis, please discuss this in session. 

Insurance does not typically reimburse couples therapy. Your insurance requires a diagnosis to prove that your therapy is “medically necessary” not just that you are experiencing grief or having issues in your relationship. For this reason, couples therapy is not typically reimbursed by insurance providers. Talk to your insurance and therapist about specific coverage for couples therapy. 

How to: Submitting a Super Bill to Insurance

Step 1: Check whether you have out of network coverage (OON).

You can call your insurance directly to inquire about your out of network coverage, or use Thrizer to check your OON coverage.

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:

  • Do I have out-of-network coverage for mental health services? Does that include services through telehealth?

  • 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 90837*?

  • Does my insurance plan cover Z codes for couples therapy**?

  • What is my co-payment (if applicable)?

  • Do I need prior authorization?

  • Do I need approval from my primary care provider? 

  • What is the home and mailing address on my file? (This is important to ensure reimbursement checks are sent to the correct address.)

  • How do I submit a super bill? Is there an online portal or do I have to mail or fax a copy?

  • What is the time limit to submit a super bill? 

*CPT codes refer to the type of service you received. CPT code 90837 refers to a clinical 60 minute session (a clinical hour is typically 50 minutes to allow time for documentation). 

*Z codes are typically not covered by insurance. These codes can include Problems Related to Employment and Unemployment (Z56) Z56.0, Problems Related to Housing and Economic Circumstances (Z59) Z59.0, and Problems in Relationship with Spouse or Partner Z63. 0. For this reason, couples therapy is not typically covered by insurance but be sure to check with your insurance about your specific out of network coverage. 

Step 2: Use Thrizer or submit your super bill directly to insurance.

Thrizer is a third-party platform that can help you verify your out of network (OON) benefits and instantly reimburse you for sessions after you meet your deductible. They handle all interactions with insurance and you can just pay your co-pay (after you meet your deductible). You’ll need to make an account with Thrizer to use this service. If interested, please reach out at info@wilsonlmft.com for support checking if you’re eligible for out of network (OON) benefits.

If submitting to insurance directly, insurances typically have a time limit to turn in your super bill of 90 days or more, some up to 180 days. This can fall under “timely filing”. To submit your super bill, contact your insurance company and ask for “member services” or check their website for instructions. There are usually 3 options for turning in a super bill: mail, fax, or through an online portal. 

  1. Mail - you can ask your insurance for an address to mail the super bill. Make sure you allow time for delivery to stay within your limit for timely filing. 

  2. Fax - if you would like to keep your protected health information private, we suggest not faxing from a public fax machine (such as at the library) or a work fax machine. The receipt that shows your fax was sent will include this private health information. 

  3. Online portal - most insurance providers will have an online portal through which you can upload your super bill. It is the most secure option to send your super bill as the website will request a login or password. It is also faster than mail or fax. Be sure to ask your insurance about this option. 

Step 3: Wait for reimbursement

Insurance companies typically have a time limit in which you can submit a super bill. If you submit your super bill after this time limit, you risk losing any potential reimbursement. 

It can typically take your health insurance 2-4 weeks to process your super bill. They will either pay the full amount of services minus your copay, or they will put this amount towards your deductible. If your super bill is denied, call your insurance and request information about the denial.