If you run a private pay therapy practice, superbills are one of the most valuable tools you can offer your clients. These detailed receipts allow clients to seek reimbursement from their insurance companies for out-of-network mental health services, often recovering 50% to 80% of their session costs. Understanding how to create accurate superbills and educate clients about the process can significantly reduce financial barriers to care while keeping your practice free from insurance panel constraints.
What Is a Superbill?
A superbill is a detailed receipt that contains all the information an insurance company needs to process an out-of-network reimbursement claim. Unlike a simple payment receipt, a superbill includes diagnostic codes, procedure codes, provider credentials, and other clinical details that insurance companies require to evaluate claims.
Think of a superbill as a bridge between your private pay practice and your client's insurance benefits. You maintain your independence from insurance panels while still helping clients access their out-of-network mental health coverage. The client pays you directly at the time of service, then submits the superbill to their insurance company for partial reimbursement.
Superbill vs. Standard Receipt
Standard Payment Receipt
- Provider name and contact
- Date and amount paid
- General description of service
- Payment method
- Not accepted for insurance claims
Superbill (Insurance-Ready)
- Provider NPI and license numbers
- CPT procedure codes
- ICD-10 diagnostic codes
- Client insurance information
- Accepted for OON reimbursement
Why Offer Superbills to Your Clients?
Offering superbills creates a win-win situation for both you and your clients. You maintain the freedom of a private pay practice without the administrative burden of insurance credentialing and claims processing, while clients can still access their mental health benefits and reduce their out-of-pocket costs.
Benefits for Your Practice
Many therapists choose to remain out-of-network specifically because it allows them to focus on clinical work rather than insurance administration. When you offer superbills, you get the best of both worlds:
- No credentialing delays: Skip the 3 to 6 month insurance panel application process
- Set your own rates: Charge what your services are worth without fee schedule constraints
- Reduced administrative burden: No prior authorizations, claim denials, or clawbacks to manage
- Immediate payment: Collect payment at time of service instead of waiting 30 to 90 days
- Clinical autonomy: Make treatment decisions based on client needs, not insurance requirements
Benefits for Your Clients
Clients who understand their out-of-network benefits often find that working with a private pay therapist is more affordable than they initially assumed:
- Access to preferred providers: Choose the right therapist, not just whoever is in-network
- Significant cost recovery: Many plans reimburse 50% to 80% of the allowed amount
- No referral requirements: Start therapy immediately without jumping through hoops
- Privacy benefits: Some clients prefer that claims not appear on shared family accounts
- Continuity of care: Keep working with you even if your panel status changes
Client Education Opportunity
Many clients assume that "out-of-network" means "not covered at all." During your initial consultation, take a few minutes to explain that most PPO and POS plans include out-of-network benefits. This simple education can turn a hesitant prospect into a committed client.
Required Superbill Elements
A complete superbill must contain specific information that insurance companies need to process claims. Missing or incorrect information is the most common reason for claim denials or delayed reimbursement. Here is everything your superbill must include:
Complete Superbill Checklist
Understanding CPT Codes for Therapy
Current Procedural Terminology (CPT) codes describe the specific services you provided. Using the correct CPT code is essential for proper reimbursement. Here are the most common codes for outpatient mental health services:
Place of Service Codes
The place of service (POS) code indicates where therapy was provided. Using the wrong code can result in claim denials:
- 11: Office (in-person sessions at your practice location)
- 02: Telehealth (video sessions when client is at home)
- 10: Telehealth in patient's home (alternative code some insurers prefer)
- 12: Client's home (in-person home visits)
Creating Professional Superbills
Your superbill reflects your professionalism and attention to detail. A well-designed superbill not only looks credible to insurance companies but also makes the submission process easier for your clients.
Design Best Practices
When creating your superbill template, keep these principles in mind:
- Clear organization: Group related information together (provider info, client info, service details)
- Readable fonts: Use professional, easy-to-read fonts at 10pt or larger
- Adequate white space: Avoid cramming too much information into a small space
- Professional header: Include your practice name, logo (optional), and contact information
- Consistent formatting: Use the same layout for every superbill you generate
Practice Management Software Advantage
Modern practice management platforms like TheraFocus can generate superbills automatically from your session notes. This eliminates manual data entry, reduces errors, and ensures every superbill contains all required elements. Clients can download their superbills directly from a client portal, saving you time on administrative requests.
Manual vs. Automated Superbill Generation
Manual Creation
- Time-consuming data entry
- Higher risk of typos and errors
- Inconsistent formatting
- Difficult to batch multiple sessions
- No automatic code validation
Automated Generation
- One-click generation from session data
- Pre-populated client and provider info
- Consistent professional formatting
- Batch superbills for date ranges
- Built-in code validation
Helping Clients Understand OON Benefits
One of the biggest barriers to clients using out-of-network benefits is simply not understanding how they work. Taking time to educate clients during intake can significantly increase the likelihood they will submit superbills and continue treatment.
Key Concepts to Explain
Help clients understand these fundamental concepts about their out-of-network mental health coverage:
- Out-of-network deductible: The amount clients must pay before insurance begins reimbursing (often separate from in-network deductible)
- Coinsurance: The percentage of allowed amount the plan pays after deductible is met (commonly 50% to 80%)
- Allowed amount: The maximum amount insurance considers "reasonable and customary" for a service
- Out-of-pocket maximum: The most a client will pay in a plan year before insurance covers 100%
- Timely filing limit: The deadline for submitting claims (usually 90 days to 1 year from service date)
Client Benefit Verification Script
Provide clients with this script to call their insurance company and verify their out-of-network mental health benefits:
Questions to Ask Your Insurance Company
- "Do I have out-of-network mental health benefits?"
- "What is my out-of-network deductible, and how much have I met?"
- "What is my coinsurance percentage for out-of-network mental health services?"
- "What is the allowed amount for CPT code 90837 (or your session code)?"
- "Is there a session limit for mental health services?"
- "What is the timely filing deadline for out-of-network claims?"
- "Where do I submit superbills for reimbursement?"
- "Can I submit claims online through the member portal?"
Pro Tip: Create a Benefits Worksheet
Give clients a simple worksheet to record the answers to these questions. Having this information written down helps them understand their expected reimbursement and keeps them motivated to submit claims consistently.
Sample Client Handout
Consider providing new clients with a one-page handout that explains:
- What a superbill is and why it matters
- How to verify their specific out-of-network benefits
- Step-by-step instructions for submitting claims
- Realistic expectations for reimbursement timeline
- Your policy for providing superbills (frequency, format)
Common Superbill Errors to Avoid
Even small errors on a superbill can result in claim denials or delayed reimbursement. Here are the most common mistakes and how to prevent them:
Top Superbill Errors That Cause Denials
The client name on the superbill must exactly match the name on the insurance card. Watch for nicknames, maiden names, and Jr./Sr. suffixes.
Your 10-digit NPI must be accurate. Double-check this number and verify it matches your NPPES registration.
Using code 11 (office) for telehealth sessions or vice versa will trigger denials. Match the code to the actual service location.
ICD-10 codes are updated annually. Using outdated or discontinued codes results in automatic denials.
Blank fields for date of birth, member ID, or group number will delay processing. Verify all fields are complete.
Using 90837 (53+ minutes) for a 45-minute session is incorrect. The CPT code must reflect actual session duration.
Quality Control Checklist
Before providing any superbill to a client, run through this quick verification:
- Client name matches insurance card exactly
- Date of birth is correct
- Insurance ID and group number are accurate
- Service date matches your session notes
- CPT code reflects actual session duration
- Diagnosis code is current and clinically appropriate
- Fee matches your stated rate
- Your NPI and license number are correct
- Place of service matches how session was conducted
Digital vs. Paper Superbills
The format you use to provide superbills affects both client convenience and your administrative efficiency. Most practices now offer digital superbills, though some clients still prefer paper copies.
Digital Superbills (PDF)
- Easy to email or download from portal
- Client can submit online to insurer
- Environmentally friendly
- Easy to store and organize
- Can batch multiple sessions easily
- Reduces printing and mailing costs
Paper Superbills
- Some clients prefer physical copies
- Required by some insurers for mailed claims
- Can be handed to client after session
- No technology barriers for clients
- Original signature if required
- Higher administrative overhead
Client Portal Benefits
Offering superbills through a secure client portal provides the best experience for both you and your clients:
- Self-service access: Clients can download superbills anytime without contacting you
- Automatic generation: Superbills are created automatically after each paid session
- Date range selection: Clients can generate superbills for specific periods (monthly, quarterly)
- Secure delivery: No risk of email interception or lost mail
- Reduced inquiries: Fewer emails and calls requesting superbill copies
Timing and Frequency
Establishing clear policies about when and how often you provide superbills sets appropriate expectations and reduces administrative burden.
Common Superbill Schedules
Best for clients who submit claims regularly. Provides consistent documentation.
Most common approach. Clients receive superbill after each appointment.
Client requests superbills as needed. Reduces unnecessary generation.
Policy Considerations
When establishing your superbill policy, consider:
- Payment timing: Only provide superbills for sessions that have been paid in full
- Retroactive requests: How far back will you generate superbills? One year is common.
- Format options: Will you provide both digital and paper formats?
- Fees: Some practices charge a small fee for retroactive or paper superbills
- Turnaround time: How quickly will you fulfill requests? 24 to 48 hours is reasonable.
Include It In Your Policies
Document your superbill policy in your informed consent or financial agreement. This prevents misunderstandings and ensures clients know exactly what to expect. Be specific about timing, format, and any associated fees.
Helping Clients Submit Claims
While you cannot submit claims on behalf of out-of-network clients (that would make you a participating provider), you can provide guidance that makes the submission process easier.
Submission Methods
Most insurance companies accept out-of-network claims through multiple channels:
- Online member portal: Fastest method. Most insurers allow claim submission with document upload.
- Mobile app: Many insurers have apps that allow photo submission of superbills.
- Email: Some insurers accept claims via secure email (less common).
- Mail: Traditional method. Include a claim form with the superbill.
- Fax: Still accepted by many insurers, especially for paper claims.
Third-Party Submission Services
Some clients use services like Reimbursify, Better, or Thrizer to handle claim submission. These services:
- Submit claims on the client's behalf
- Track claim status and follow up on denials
- Charge a percentage of reimbursement or flat fee
- May increase successful reimbursement rates
You can mention these services to clients who feel overwhelmed by the submission process, but avoid endorsing any specific service.
Tracking Reimbursement Success
Understanding how well your clients are being reimbursed helps you counsel new clients about what to expect and identify any patterns in claim denials.
Information to Track
Consider asking clients to share their Explanation of Benefits (EOB) so you can track:
- Allowed amount vs. your billed rate
- Reimbursement percentage after deductible
- Common denial reasons
- Processing time by insurer
- Which insurers are most favorable for OON claims
This data helps you provide realistic expectations to prospective clients with similar insurance plans.
Frequently Asked Questions
Can I provide superbills if I am in-network with some insurance companies?
Yes, but only for clients whose insurance you are out-of-network with. If a client has insurance where you are in-network, you typically must bill the insurance directly according to your provider agreement. Providing superbills to in-network clients instead of billing directly could violate your contract.
What if my client's insurance denies the claim?
Review the denial reason with the client. Common issues include missing information (which you can correct and resubmit), diagnosis not covered (may need clinical review), or deductible not met (client responsibility). Clients can appeal denials, and you can provide additional documentation if requested.
Should I include my diagnosis on the superbill if the client wants privacy?
A superbill requires a diagnosis code for insurance reimbursement. Discuss this with clients during informed consent. Some clients choose not to submit for reimbursement to maintain complete privacy. Others accept that the diagnosis will appear on insurance records. This is the client's decision to make.
How long should I keep copies of superbills I have issued?
Retain superbill records for at least 7 years, which aligns with most state requirements for medical records. Some states require longer retention. Superbills are part of the financial record of treatment and may be needed for audits, legal matters, or client requests.
Can I charge more than usual if a client is not using insurance?
Your fee should be consistent regardless of whether a client plans to submit for reimbursement. Charging different rates based on insurance status could be considered discriminatory. Set your rate based on your services, credentials, and market, then apply it consistently.
What if a client asks me to change the diagnosis for better reimbursement?
Never alter a diagnosis for insurance purposes. The diagnosis on a superbill must accurately reflect your clinical assessment. Falsifying a diagnosis is insurance fraud, which carries serious legal and ethical consequences. Explain this clearly if a client makes such a request.
Do all insurance plans have out-of-network benefits?
No. HMO plans typically do not cover out-of-network providers except in emergencies. EPO (Exclusive Provider Organization) plans also usually lack OON benefits. PPO and POS plans most commonly include out-of-network coverage. Clients should verify their specific plan details.
Key Takeaways
- ✓ Superbills allow private pay clients to seek reimbursement from their insurance, often recovering 50% to 80% of session costs through out-of-network benefits.
- ✓ Every superbill must include provider NPI, client insurance information, CPT procedure codes, ICD-10 diagnosis codes, dates of service, and fees charged.
- ✓ Educating clients about their out-of-network benefits during intake increases the likelihood they will submit claims and continue treatment.
- ✓ Common superbill errors like mismatched names, incorrect codes, and missing fields cause claim denials. Use a checklist to verify accuracy before providing superbills.
- ✓ Practice management software can automate superbill generation, reducing errors and saving significant administrative time.
- ✓ Establish clear policies about superbill timing, format, and any fees, and document these in your client agreements.
Simplify Your Superbill Process
TheraFocus generates professional superbills automatically from your session documentation. Clients can download superbills directly from their portal, saving you hours of administrative work each month.
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TheraFocus Team
Practice Management Experts
The TheraFocus team is dedicated to empowering therapy practices with cutting-edge technology, expert guidance, and actionable insights on practice management, compliance, and clinical excellence.