What is a Superbill?
A superbill is essentially a detailed receipt that includes important information like diagnosis and procedure codes. It’s designed to help you request reimbursement from your insurance for services provided by out-of-network providers. After you submit your superbill, your insurance company may reimburse you for part or sometimes all of the costs, depending on your out-of-network benefits.
How Out-of-Network Reimbursement Works
Each insurance company has its own network, which refers to a list of approved providers. While you can see providers who are both in and out of network, seeing providers in network often has a lower out-of-pocket cost. But, some people choose out-of-network providers because it gives them more choice and flexibility in selecting their therapist.
Preferred Provider Organization (PPO) plans are popular for their flexibility. They let you see in-network and out-of-network providers without needing referrals. Plus, they usually offer some reimbursement for out-of-network care. PPOs often reimburse “usual, customary, and reasonable” (UCR) fees for services. However, PPOs usually only cover part of the UCR fees for out-of-network providers.
If Octave isn’t in your network, then it may still be possible to get reimbursed for services. Once you finish your onboarding form, our billing team will contact your insurance company to learn more about your coverage and benefits. Using this information, you’ll get a price range to help you know what you can expect to pay before you start care at Octave.
How to Use a Superbill to Get Reimbursed
Therapy insurance claims can seem complicated, but there are a few steps that you can follow to make it easier:
Obtain your superbill: The billing team will provide you with a superbill. Once you obtain your superbill, check it over to ensure that it is accurate prior to submitting. Your superbill should contain:
Personal details (Full name, date of birth, address, phone number, insurance information)
Provider information (Full name, TIN, office address, and phone number)
Dates of service
CPT codes (describes the service provided)
ICD codes (describes the condition or symptoms treated)
Amount paid and balance
Modifiers (for telehealth)
Signature of the healthcare provider (digital is okay)
Check with your insurer for their submission process: Your insurance provider requires you to submit your superbill via their online portal, or through mail or fax. You’ll also want to check if there are any time restrictions. For example, you may need to submit your superbill within 90 days.
Follow the instructions: Follow your insurer’s instructions for submitting your superbill. If you are submitting via mail or fax, ensure that you have the correct address.
Monitor your claim: If your insurance provider uses a portal, then you can usually check the status of your claim through this portal.
Here’s What the This Superbill Process Looks Like at Octave
Have your session with the therapist
Receive your superbill from your therapist. If you are self-pay and see a therapist regularly, Octave will send you your superbills once a month
Submit your superbill
Wait for explanation of benefits (EOB)
The EOB tells you how your claim was processed. This includes the services and how much your insurance company paid.
Common Questions About Therapy Superbills
Here are some mental health insurance FAQs and their explanations:
Do I need pre-authorization?
Some insurance providers do require pre-authorization for accessing out-of-network providers. It’s best to check with your insurance provider about your plan to see if pre-authorization is required.
Will insurance always reimburse me?
Various insurance plans provide different coverage for out-of-network providers. This means that not every plan will reimburse you. Before starting therapy, it’s best to check with your insurance provider about what is covered.
How long does it take to get paid back?
How long it takes to get paid can vary depending on your provider and whether there are any issues with your claim. However, most people are reimbursed within 2-4 weeks.
How Octave Supports You with Reimbursement
Coordinating out-of-network therapy services with insurance can be overwhelming, but you’re not alone in the process. After your therapy appointment, Octave will provide you with a superbill, as well as steps for how to submit this to your insurance company.
Here are some tips for how to maximize your plan’s benefits
Understand your plan details: Knowing what your plan covers helps you get the most out of your benefits. For example, your insurance company may only cover a certain number of therapy sessions. You’ll also want to know if you have a deductible, copay/coinsurance, or any other out-of-pocket expenses.
Submit claims within the claim window: Most insurance companies set deadlines for filing a claim after you get the service. This could be anywhere from 90 days to 365 days from the date of your session. Submitting your claim within your claim window ensures that you receive the coverage offered. In general, the sooner you submit your claim, the sooner you will be reimbursed.
Appeal any denied claims or low reimbursements: If you feel that your claim was denied or reimbursed unfairly, it's a good idea to submit an appeal. While the outcome depends on your unique situation, you have a legal right to appeal, and research has shown that up to 75% of appeals are successful.
Is Out-of-Network Reimbursement Right for You?
Choosing between out-of-network and in-network reimbursement is a personal choice. Each option has its pros and cons. Benefits of out-of-network therapy services include:
More specialists: Because in-network therapists can be limited, choosing an out-of-network therapist offers you a greater variety of therapists to choose from. This helps you find a therapist with specific skills. For example, you can look for someone experienced with LGBTQ+ individuals or those dealing with racial stress.
Ability to start therapy more quickly: In some areas, therapists may have waiting lists. If you don’t want to wait to start therapy, seeking an out-of-network therapist can help you get started faster.
More variety: Ensuring that you feel comfortable with your therapist is important. Because you have more therapists to choose from when going out of network, it can make it easier to find someone who is a good match for you.
Cons of using out-of-network therapy services include:
Costs can be higher: Although it depends on your specific insurance plan, costs are often higher for seeing out-of-network providers.
Can be time-consuming: Submitting and managing claims can be time-consuming.
Higher initial fees: You often need to pay for therapy services upfront, even if your insurance company reimburses you later.
Choosing an out-of-network therapist might be a better choice for you if you’re able to connect with a therapist that you work well with. Out-of-network therapists can also provide more flexibility with session length and frequency. This might fit your unique needs better.
If you’re navigating out-of-network reimbursement, then there are a few tools that can help. These include:
Reimbursify: Checks your out-of-network coverage and allows you to easily submit claims and check their status.
Thrizer: Verifies your out-of-network benefits, submits superbills, and deposits reimbursements to your bank account.
CLAIMEYE: Scans your bill, sends your claim to your insurance company, and keeps you notified about the status of your claim.
Many insurance providers also have their own apps, which can help you submit claims, track claims, and get more details about your benefits. Some common ones include:
When working with Octave, the easiest way to navigate out-of-network reimbursement is to visit your Client Portal. Here, you’ll be able to update your insurance and pay your balance.
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