Therapy Superbills: How to Get Reimbursed for Out-of-Network Therapy
A step-by-step guide to using superbills for out-of-network therapy reimbursement, including what's on a superbill, how to submit claims, what to do if denied, and tools that simplify the process.
Your Preferred Therapist Does Not Take Your Insurance. Now What?
You have found a therapist you connect with, someone who specializes in exactly what you need. There is just one problem: they are out of network. Before you give up and start your search over, know this — you may still be able to get a significant portion of each session reimbursed by your insurance company.
The key is a document called a superbill.
Many people pay out of pocket for therapy without realizing they could recover 40 to 80 percent of the cost. This guide walks you through the entire process, from understanding what a superbill is to submitting your first claim and handling denials.
What Is a Superbill?
A superbill is a detailed receipt your therapist provides after a session. Unlike a regular credit card receipt, it contains specific clinical and billing codes that your insurance company requires to process an out-of-network reimbursement claim.
Think of it as the bridge between paying your therapist directly and getting money back from your insurer. Your therapist creates it, you submit it, and your insurance company uses it to determine how much to reimburse you.
Most out-of-network therapists are familiar with superbills and can provide them automatically after each session or on a monthly basis. If you are considering an out-of-network therapist, ask whether they provide superbills before your first appointment.
What Is on a Superbill?
A properly formatted superbill contains several required elements. If any of these are missing, your insurance company may reject the claim.
Provider information:
- Therapist's full name and credentials (e.g., PhD, LCSW, LPC)
- National Provider Identifier (NPI) number
- Tax Identification Number (TIN) or EIN
- Office address and phone number
Patient information:
- Your full legal name
- Date of birth
- Insurance member ID number
Session details:
- Date of service
- Place of service code (11 for an in-person office visit, 02 for telehealth)
CPT codes (Current Procedural Terminology) describe the type of service provided:
ICD-10 diagnosis codes explain why treatment is medically necessary. Common examples include F41.1 (generalized anxiety disorder), F32.1 (major depressive disorder, moderate), and F43.10 (post-traumatic stress disorder). Your therapist determines the appropriate diagnosis based on their clinical assessment.
Fee and payment information:
- The amount the therapist charged for the session
- The amount you paid
How Much Will You Get Back?
This is the question everyone wants answered first, and the honest answer is: it depends on your specific plan. But understanding a few key terms will help you estimate.
Out-of-network deductible. This is the amount you must pay out of pocket before your insurance begins reimbursing out-of-network claims. It is often separate from (and higher than) your in-network deductible, commonly ranging from $500 to $2,000.
Coinsurance rate. After you meet your deductible, your insurer reimburses a percentage of the cost. Common out-of-network coinsurance rates are 50 to 80 percent.
Usual and customary rate (UCR) or allowed amount. This is the maximum amount your insurer considers reasonable for a given service in your area. It is almost always less than what your therapist charges.
Example 1: Deductible Already Met
- Session fee: $225
- Your plan's allowed amount: $175
- Out-of-network deductible: $500 (already met)
- Coinsurance rate: 70%
- Reimbursement: 70% of $175 = $122.50
- Your net cost: $225 - $122.50 = $102.50
Example 2: Deductible Not Yet Met
- Session fee: $225
- Out-of-network deductible: $500 (only $100 met so far)
- Remaining deductible: $400
- The $225 session applies toward your remaining deductible
- Reimbursement: $0 for this session
- Your deductible balance drops to $175
In this scenario, you would need a few more sessions before reimbursement kicks in. Once the deductible is met, future sessions are reimbursed at your plan's coinsurance rate.
40-80%
Step-by-Step: How to Submit a Superbill
Step 1: Verify Your Out-of-Network Benefits Before Starting Therapy
Call the member services number on the back of your insurance card and ask these specific questions:
- Do I have out-of-network mental health benefits?
- What is my out-of-network deductible, and how much have I met this year?
- What is my coinsurance rate for out-of-network mental health services?
- What is the allowed amount for CPT code 90837 (60-minute individual therapy)?
- Is there a limit on the number of out-of-network therapy sessions per year?
- What is the filing deadline for out-of-network claims?
Write down the representative's name and a reference number for the call. This documentation protects you if there are disputes later.
Step 2: Ask Your Therapist for Superbills
Most out-of-network therapists provide superbills as a standard part of their practice. Some generate them after each session, while others send them monthly. Ask your therapist:
- Do you provide superbills?
- How often will I receive them (per session or monthly)?
- Do you use any automated submission services?
Step 3: Submit to Your Insurance
You have three options for submitting superbills:
- Online portal upload. Most major insurers now allow you to submit out-of-network claims through their member portal. This is typically the fastest method.
- Email. Some insurers accept claims via a dedicated email address. Check your plan documents or ask member services.
- Mail. You can print and mail the superbill to the claims address on your insurance card. Use certified mail or keep copies for your records.
Step 4: Track Your Claim
Log the date you submitted each superbill. Most insurers process out-of-network claims within 2 to 6 weeks. If you have not received an Explanation of Benefits (EOB) within 30 days, call member services to follow up.
Step 5: Review Your Explanation of Benefits
When your insurer processes the claim, they will send you an EOB — either electronically or by mail. Review it carefully:
- Does the reimbursement amount match what you expected based on your coinsurance rate and allowed amount?
- Was any portion denied? If so, is a reason code listed?
- Has the payment been applied correctly toward your deductible?
Step 6: Receive Your Reimbursement
Reimbursement is typically sent as a check or direct deposit to you (not to the therapist). Some insurers allow you to set up direct deposit through their portal, which speeds up the process.
Tools That Make It Easier
If submitting superbills manually feels like too much work, several services can automate the process.
Mentaya checks your out-of-network eligibility, submits claims on your behalf, and tracks reimbursement status. The service charges approximately $30 per month or a per-claim fee, which many people find worthwhile given the time saved.
Thrizer works on the therapist's side. Therapists who use Thrizer handle the billing so that you only pay your estimated out-of-pocket portion upfront, rather than the full fee. Ask your therapist if they use Thrizer.
Reimbursify is an app that helps you photograph, submit, and track superbills from your phone.
Some therapists also use practice management software that auto-generates superbills and can submit them electronically on your behalf.
What If Your Claim Is Denied?
A denied claim is not necessarily the end of the road. Common denial reasons include:
- Missing or incorrect information on the superbill (wrong CPT code, missing NPI number, etc.)
- Services not covered under your specific plan
- Deductible not yet met (the claim was processed correctly, but your deductible applies first)
- Timely filing exceeded (you submitted the claim after your plan's filing deadline)
- Diagnosis not covered (some plans exclude certain diagnoses)
How to Appeal
- Request the written denial reason. Your insurer is required to provide a specific explanation.
- Gather documentation. Ask your therapist to provide a letter of medical necessity if the denial is related to coverage.
- File an internal appeal. Submit a written appeal within your plan's appeal window, which is typically 180 days from the denial date. Include supporting documentation and a clear explanation of why the claim should be covered.
- Request an external review. If the internal appeal is denied, you have the right to an independent external review by a third party not affiliated with your insurer.
- Contact your state insurance commissioner. If you believe your insurer is acting in bad faith or violating mental health parity laws, your state insurance commissioner can investigate.
Mental Health Parity Protections
Under the Mental Health Parity and Addiction Equity Act, if your plan covers in-network mental health services, it must provide out-of-network mental health benefits that are comparable to out-of-network medical and surgical benefits. If your plan covers out-of-network visits to a cardiologist, it cannot deny coverage for out-of-network visits to a therapist. This is a powerful tool when appealing denials.
Superbills vs. In-Network: Pros and Cons
Out-of-Network (Superbill) vs. In-Network Therapy
| Factor | Out-of-Network (Superbill) | In-Network |
|---|---|---|
| Cost to you | Higher upfront; partial reimbursement after deductible | Lower copay or coinsurance; no claim submission needed |
| Therapist choice | Widest possible selection; choose any licensed therapist | Limited to your insurer's network |
| Paperwork | You submit superbills and track claims | Therapist bills insurer directly; minimal paperwork for you |
| Privacy | Diagnosis still reported to insurer when you submit the superbill | Diagnosis reported to insurer by the therapist |
| Wait times | Often shorter; more availability | Can be longer due to limited in-network providers |
| Session limits | Subject to plan limits, but often fewer restrictions | May require prior authorization after a set number of sessions |
For many people, the out-of-network route is worth the extra paperwork because it opens up a much larger pool of therapists. This can be especially valuable if you need a specialist — for example, a therapist trained in EMDR for PTSD or DBT for emotional regulation — and cannot find one in your network. For more on how much therapy costs across different payment methods, see our cost guide.
Tips for Maximizing Your Reimbursement
Meet your deductible early. If you know you will be attending therapy throughout the year, consider front-loading sessions in January to meet your deductible sooner. Every session after the deductible is met gets partially reimbursed.
Ask about single case agreements. If there are no in-network therapists available who meet your needs, ask your insurer for a single case agreement. This is a formal arrangement where your insurer agrees to cover an out-of-network therapist at in-network rates. Document your search efforts, including names and dates of in-network providers you contacted who were unavailable.
Use HSA or FSA funds for the unreimbursed portion. The amount your insurance does not cover is still a qualified medical expense. You can pay it with pre-tax dollars from your Health Savings Account or Flexible Spending Account.
Combine with your EAP. If your employer offers an Employee Assistance Program, you may be able to use those free sessions (typically 3 to 8) while working toward meeting your out-of-network deductible with superbills from a different provider.
Choose therapists whose fees are close to the allowed amount. The smaller the gap between your therapist's fee and your insurer's allowed amount, the more of each session is eligible for reimbursement.
Submit claims promptly. Most plans have filing deadlines ranging from 90 days to one year from the date of service. Do not let superbills pile up. Set a recurring calendar reminder to submit them monthly.
For more strategies on paying for therapy, see our guide on whether insurance covers therapy and our overview of therapists who take insurance in Maryland.
Frequently Asked Questions
Most insurance companies process out-of-network claims within 2 to 6 weeks after submission. If you submit through your insurer's online portal, processing tends to be faster. If you have not received an Explanation of Benefits within 30 days, contact your insurer's member services to check the status of your claim.
Yes. Telehealth therapy sessions are eligible for superbill reimbursement just like in-person sessions. The superbill will include place of service code 02 (telehealth) instead of 11 (office). Most insurance plans cover telehealth at the same rate as in-person visits.
Yes. Insurance companies require a clinical diagnosis (ICD-10 code) on the superbill to process the claim. Your therapist will assign an appropriate diagnosis based on their assessment. This is standard practice and does not mean anything is 'wrong' with you — it is simply how the billing system works.
It depends on your plan. Many insurers cover couples therapy (CPT code 90847) when one partner has a diagnosable mental health condition. The superbill would list that partner as the identified patient. Some plans exclude couples or family therapy from out-of-network benefits entirely, so verify with your insurer before starting.
Most licensed therapists can generate superbills, but some may not be familiar with the process. If your therapist does not currently provide them, ask if they would be willing to start. You can also ask whether they use a practice management system that can auto-generate superbills. If they cannot or will not provide superbills, this is worth knowing before committing to treatment.
Your employer does not see individual claims or diagnoses. When you submit a superbill, the information goes to your insurance company, not your employer. However, the diagnosis does become part of your insurance record. If privacy is a significant concern, paying fully out of pocket without submitting to insurance is the only way to keep your diagnosis entirely private.
The Bottom Line
Out-of-network therapy does not have to mean paying full price. Superbills give you a clear path to recovering a meaningful portion of your therapy costs while maintaining the freedom to choose the therapist who is the best fit for you. The process takes some upfront effort — verifying your benefits, submitting paperwork, and tracking claims — but the financial payoff is real. For many people, recovering $100 or more per session makes the difference between affording ongoing therapy and having to stop. Start by calling your insurance company, asking the right questions, and requesting your first superbill. For broader context on therapy costs and payment options, explore our FAQ section.
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