What are superbills? Everything you need to know!

What is a superbill?

A superbill is a detailed, itemized receipt from a healthcare provider that patients can submit to their insurance company for reimbursement. It is generally used with regards to out of network benefits. It works when you as the client or patient pays your healthcare provider directly for services and then submit your bill directly to the insurance company for reimbursement. Some information that is important for a superbill to include is patient and provider information, dates of services, diagnosis, procedure codes (CPT), and charges. You would receive a superbill from a provider who is out of network from your insurance company. So in the case of therapy, if your therapist is not in network with your insurance company, but you have and want to use your out of network benefits. You would pay your therapist for their services and they would provide your a superbill which you would provide to your insurance company for reimbursement.

But first, what is the difference between in network and out of network (OON)?

In network refers to a provider who has a contract with the insurance company. They have negotiated a price per service. When a provider is in network, they “bill” or submit a claim to your insurance directly on your behalf to get “paid” for services.

Out of network (ONN) refers to provider who does not have contract with insurance company. Therefore, the provider does not have a set price for the service. Because there is no contact between the provider and insurance company, the provider does not submit a claim directly to the insurance company, but can provide the patient/client with a superbill in order to get reimbursed directly from the insurance company for service rendered and paid.

To put it very simply, in network means the therapist (in therapy terms) would bill the insurance company directly on your behalf. And out of network, means superbill which you as the client would “bill” the insurance company.

Many insurance plans have both in network and out of network benefits. It is best to contact your specific insurance company to find out your specific benefits as they vary greatly from insurance company and plan to plan.

What are some benefits of superbills and/or utilizing out of network benefits?

It provides you, the client, access to more providers as you are not limited to choose only in network providers. You’ll have greater opportunity to find a great fit in a therapist that you may never had the opportunity to utilize otherwise. It gives you the freedom to choose from more therapists, including specialists. It provides you cost transparency as you know the cost of therapy upfront and do not have to guess if or how much insurance will cover as you would have to pay for therapy upfront. How frustrating is it to think that your service is covered only to find out that it wasn’t? And because you receive a breakdown of the costs, you can have a clearer understanding of the financial side of your therapy costs. You will meet your deductibles quicker by utilizing your out of network benefits, because a majority of out of network benefits are deductible related. Submitting every superbill will help you meet your deductible quicker. You will have clear documentation of your medical expenses and evidence for insurance claims. There is greater transparency in costs and better understanding in the financial side.

Are there any downfalls to superbills?

With anything there are downfalls and the main one with superbills includes that you have to front the money initially. It does place a financial burden on you initially and you’ll have to wait to be reimbursed by the insurance company. If you have a large deductible, you also may not be reimbursed at all. There is also the administrative complexities of having to deal with the insurance company directly, and that can be frustrating.

How do I get started with superbills?

The first step would be to understand your out of network benefits. To do this, you should reach out to your insurance company directly and get clarification of benefits and the superbill submission process. Then you would ask your provider for a superbill and they would provide you with one, which most provide on a monthly basis. You would then submit the superbill to your insurance company for reimbursement. The insurance company could request additional information. It can be helpful to ask your insurance company about their superbill process as well as your provider regarding any questions.

There is no one size fits all when it comes to deciding if to utilize your out of network benefits. It is a wholly individual decision, but hopefully this short summary gives you clarity on the complexity of superbills to help you make the decision for yourself. Please reach out with additional questions!

*This is meant for educational purposes. Please contact your insurance provider for clarification on benefits.