Superbills: Accessing your out-of-network benefits

To receive potential reimbursement for therapy through your health insurance, use a superbill. Here's what you need to know:

In-Network vs. Out-of-Network Benefits: In-network benefits typically offer lower costs because the therapist has an agreement with the insurance company. Out-of-network benefits, however, allow you to see any therapist, but the reimbursement rates are usually lower, and you may need to pay more upfront.

What is a Superbill? A superbill is a document detailing the therapy services you received, generated monthly by our system. It includes:

• Client info (name, address, DOB)

• Therapist info (name, contact, Tax ID, NPI)

• Diagnosis and CPT codes (A Current Procedural Terminology (CPT) code is a number that identifies a medical procedure or service.)

• Date, service, and fees paid

How to get started:

Call the member services number on your insurance card and ask these questions to verify out-of-network coverage:

• Do I have out-of-network coverage for telehealth mental health services?

• What is my yearly deductible and how much has been met?

• How many sessions does my plan cover each year?

• What does my insurance reimburse for mental health CPT codes?

  • Commonly used CPT codes at Puyallup Child and Teen Therapy:

    • 90791 - Assessment session

    • 90834 - Individual therapy session (45 minutes)

    • 90837 - Individual therapy session (60 minutes)

    • 90846 - Family therapy session without client present

    • 90847 - Family therapy session with client present

    • 90839 - Crisis therapy session

• Do I need prior authorization or approval from my primary care provider?

• How do I submit a superbill? Is there an online portal or do I need to mail/fax it?

• What is the time limit for submitting a superbill?

How to Submit a Superbill: You generally have 90-180 days to submit a superbill. To submit, contact your insurer for instructions or check their website. Options include:

1. Mail – Send to the address provided, allowing time for delivery.

2. Fax – Avoid using public or work fax machines for privacy.

3. Online Portal – Secure and fast; ask your insurer about this option.

After Submission: Insurance usually takes 2-4 weeks to process your superbill. You’ll either be reimbursed minus your copay, or it’ll go toward your deductible. If denied, contact your insurance for details.

Here is an example of a superbill you would receive from me.

Notice the key information on there:

• The client’s information

• The therapist’s information

• The diagnosis codes

• CPT code

• Date of service

• Fees paid