Are you tired of paying high costs for counseling? If so, you may be wondering how to get reimbursed for out-of-pocket therapy sessions. One way to do this is by submitting a Superbill to your health insurance provider (e.g, BCBS HMO). Here at Ace Counseling Group, out-of-network services may be covered in full or in part by your health insurance or employee benefit plan by providing them a Superbill. Check out our rates and in-network insurance providers here!
What is a Superbill?
A Superbill is a statement of services provided by an out-of-network counselor, such as a psychiatrist, psychologist, or licensed social worker. It includes information like the date of service, service codes, diagnosis codes, and the amount billed. Patients can use a Superbill to submit to their health insurance for reimbursement. The amount reimbursed will depend on the individual’s healthcare policy.
Superbills may also be called different names such as claim forms, encounter tickets, fee tickets, invoices of service, receipts of service, or statements of service. However, they all contain the necessary information for the healthcare insurance company to process the claim.
What must be included on a Superbill?
Are you unsure of what information must be included on a Superbill? While the format may vary, it is crucial that all required details are present for the submission of a successful claim.
Patient and Provider Information
A Superbill must include information about the behavioral or mental health professional who provided the therapy, as well as specific details about the patient. This includes:
- Provider’s first and last name
- Provider’s NPI number and/or tax identification number
- Office location where services took place
- Provider’s phone number
- Provider’s email address
- Referring provider’s first and last name (if applicable)
- Referring provider’s NPI number (if applicable)
- Patient’s first and last name
- Patient’s address
- Patient’s phone number
- Patient’s date of birth
Note: An NPI (National Provider Identifier) is a unique 10-digit number used to identify healthcare providers.
All healthcare providers who are HIPAA-covered entities must obtain an NPI. Also, as the therapist is not credentialed with the patient’s insurance, the patient’s member ID will need to be included on a cover letter when the claim is forwarded to insurance.
Service Dates, Codes, and Fees
The Superbill must include important information about the therapy session, such as the diagnostic code (DX), date(s) of service (DOS), and the fee for each service date. These may include:
- Date of Service
- Procedure Code (CPT)
- Diagnosis code (DX)
- Modifiers (if applicable)
- Units or minutes
- Fee charged
How to Request and Submit a Superbill
Most providers do not automatically offer a Superbill, but will provide one upon request. Once obtained, the Superbill can be submitted to your healthcare insurance. However, each insurance company has different policies, so it’s best to call your individual insurance company to obtain your plan benefits and verify the process for submitting a Superbill.
To ensure your submission is accepted, you should verify your out-of-network benefits, confirm the process for submitting a Superbill, and make sure your insurance company has your correct address on file. You can find the phone number for “Members” or “Member Services” on the back of your insurance card. During this call, which may take 10-20 minutes, you should have your insurance card and a notebook to take notes.
If your address needs to be updated, you’ll need to contact the Human Resources Benefits Specialist from the employer who sponsored the plan. The individual in the household that works with the employer will need to follow the employer policies to update the address at work and for the healthcare insurance.
Understanding your healthcare insurance is important for managing out-of-pocket expenses. When submitting a Superbill for an out-of-network provider, it’s essential to know what benefits you’re eligible for. Below are some key questions to ask your insurance company before submitting your Superbill:
- What are my out-of-network healthcare benefits for behavioral health in an out-patient setting?
- Is pre-authorization required?
- What is the co-payment, if any?
- What is the deductible and what is the current accumulation towards it?
- What is the co-insurance amount?
- What is the timely filing limit?
If pre-authorization is required, ask the representative to start the process. They will typically need the patient’s name, date of birth, and member number, along with the name and address of the mental health professional who will provide the therapy.
Next, ask about the process for submitting a Superbill. Each insurance company may have different options such as faxing, mailing, or uploading the Superbill through a secure portal. When uploading the Superbill, you will need to include a cover letter with the patient name and member identification number. If you submit via the insurance portal, you will need to check if an invitation from the insurance company is required, otherwise, ask for the web address of the insurance portal and the login credentials.
What to Expect After Submitting a Superbill
Once a claim is received by the insurance company, they usually take 2 weeks to make a determination. If reimbursement is approved, the insurance company typically mails the check on a specific day of the week. If the claim is processed correctly and applied to the deductible, no payment will be made.
What if I don’t receive payment after submitting my Superbill? If you don’t receive payment within 2 weeks of submitting your Superbill, you should call the “Member Services” number on the back of your healthcare card to check the status of your claim. The representative will ask for the dates of service and the total amount of charges. They will inform you of the status of the claim, whether it was denied, in process, or completed.
My Superbill was denied, what should I do? If your claim is denied, it’s recommended to call the insurance company and ask for an explanation. Some possible reasons for denial include:
- Prior authorization was required but not obtained
- Date(s) of service were outside the timely filing of claims
- Information on the Superbill was incomplete or illegible
- No out-of-network coverage
If you are unable to resolve the issue with the insurance company, you can contact your Human Resources Benefits Specialist from your employer. They represent your employer group with the insurance company and will do their best to resolve the issue.