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:
Mail – Send to the address provided, allowing time for delivery.
Fax – Avoid using public or work fax machines for privacy.
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
