The Complete Guide to Superbills

A superbill is a crucial tool for out-of-network healthcare billing. If you have ever seen an out-of-network (OON) provider like a therapist, dietitian, or chiropractor, you likely received a superbill. Superbills can be a bit confusing, so here at Perfect 10.0 PT we've tried to gather all the helpful information we could into one guide to make as seamless as possible for you.

 

What is a superbill (medical definition)?

A superbill is a document made for insurance companies that details the services a therapist or health care provider performed for a patient. Essentially, it’s a receipt for your visit to the doctor’s office, but unlike traditional receipts, superbills contain vital information, like diagnosis and procedure codes, needed for insurance payers to reimburse you for the services after you’ve paid. They're different from regular medical bills in that insurers use them to pay patients rather than providers.

***So don’t throw them away! 

People often underestimate how much of their superbills are eligible for reimbursement. That’s because superbills deal with out-of-network services, and people often mistakenly assume their insurance doesn’t cover OON care. 

‍

What is a superbill for insurance purposes? 

Superbills fall under the category of out-of-network billing, meaning they detail services received from a provider who is not within your insurance network. This could be a provider from a different network than yours, or a provider who chooses not to accept insurance at all (like Perfect 10.0 PT), which is common among certain specialists like physical therapists.

Usually, when you see an out-of-network provider, you pay them out of pocket for their services. Then, they provide you with a superbill detailing those services and their costs. To get your superbills reimbursed, you have to file an out-of-network claim with your insurer. Your insurer will review the claim and reimburse all, some, or none of the services depending on their assessment. 

‍

Why do therapists use superbills?

The process of joining an insurance company's network can be long and tedious. Specialists like therapists and Dr. Greene have to get on a provider panel, which requires an extensive series of applications and interviews. 

Superbills let therapists and other medical specialists provide care and get paid without being on a provider panel. They’re a neat tool for bypassing the bureaucratic hoopla and connecting specialized providers with patients. 

‍

Why are superbills important?

Think of it this way: your superbills are the keys that unlock your insurance reimbursements. If your superbills are mishandled or neglected, you won’t get paid back by your insurance. (Estimates put total annual money lost by patients to improperly filed superbills over $50 billion!) 

Check your plan’s website to see what percentage of out-of-network services your insurer has agreed to cover through coinsurance. Once you’ve met your OON deductible, your OON benefits might include up to an 80% reimbursement! 

People leave this money on the table all the time, because they simply don’t realize how many OON services are covered by their insurance plan. We really don’t want that to happen to you, so let’s go over what’s inside a sample superbill. 

‍

What does a superbill look like? 

​

 

 

 

 

 

 

 

 

 

 

 

 

Superbills may look different depending on your provider, so interpret this superbill example loosely. Regardless of who issues it though, every superbill will contain the following pieces of information. 

Contact Info:

​

Essential client info like name, date of birth, address, and phone number. Superbills also list the practitioner’s information, including the name of the practice, office location, and National Provider Identifier, or NPI number. An NPI number is a unique identification number for healthcare providers. It has been adopted as the standard provider identifier, as most healthcare providers are issued one.

 

Date and Cost of Service:

​

Superbills include the date and cost of the service provided. A superbill can contain a single appointment or many appointments (that’s what makes them super!) but any superbill must list both the date and the cost of each one service rendered.

​

Diagnosis Code:

​

Superbills contain diagnosis codes to classify client symptoms. Like NPI numbers, this is a standard practice insurance providers use for identification and billing purposes. Currently, providers use the International Statistical Classification of Disease and Related Health Problems, which is known as the ICD10. 

​

Procedure Codes:

​

The CPT code, which stands for Current Procedural Terminology, is an index of medical and health services created by the American Medical Association. CPT codes are used to describe the types of services rendered to a client. For example, there are different CPT codes for service based codes (untimed), and time-based codes (15 minutes or 8 minute rule applied).  Here is an amazing resources on the 8 Minute Billing Rule for Physical Therapy.

‍

For Patients: How to submit superbills to insurance payers

Here are a few things to consider when thinking about how to send a superbill to insurance payers. 

• Understand your benefits. 

Before you file your own out-of-network claim, it’s important to understand your OON benefits. Usually, the easiest way to do this is by viewing your plan details on your insurer’s website. Or, you can call your insurance company using the number on the back of your health insurance card. 

Questions you may want to explore include:

• Do you have out-of-network benefits? If so, what is your out-of-network deductible?

• Have you met your deductible? 

• Does your insurance plan cover the specific services you received? Some plans have exclusions to what is covered.

• What is your coinsurance rate, or the portion of the bill that is your responsibility? 

• What percentage does your insurer cover? This is the amount you may be reimbursed. 

 

• Review the submission instructions on your insurer’s website. 

In theory, sending a superbill to insurance is exactly what it sounds like, but because insurers hate making things easy for patients, submission protocols differ from one insurance company to another. Sometimes it’s as simple as uploading a claim, but some companies want you to fax or mail them. Review your plan’s website carefully to make sure you know how to send a superbill to insurance. 

• Double-check your personal information. 

Review the information you input on the claim form, especially your insurance ID numbers. More claims get rejected due to simple data errors than you might think. ​​

​

Quick FAQs and common misconceptions about superbills

Superbills are not really bills. 

The name superbill is a little misleading. Superbills are more like itemized receipts, issued after a service is paid for. They list the names and costs of your health expenses. But be careful: don’t throw your superbills away with your other receipts! You will need your superbills to file out-of-network health insurance claims.

​

Well then, what are superbills?

In literal terms, a superbill is a document an out-of-network provider gives a patient after they’ve paid for services. Sometimes they are called “encounter forms”. A superbill for insurance shows the provider’s ID, the patient’s diagnosis, and service(s) rendered. It also records their cost, the amount paid, and the patient’s name and address. 

For another analogy, think of superbills as a vehicle. Superbills transport medical data from a doctor’s office to an insurance company. The data is written in a universal language of medical codes, so that both the provider and insurer are on the same page. These codes, called ICD and CPT codes, are essential knowledge for any out-of-network provider’s billing specialist. 

​

When are superbills used over regular bills? 

When a healthcare provider or facility is in-network, it means they accept your insurance. The provider files an insurance claim and the insurer pays the provider directly. This isn’t the case for out-of-network services.

When a provider is out-of-network, they don't accept your insurance. The patient pays for the services up front. The patient needs detailed information to submit information to their insurance to file a claim. The insurer then reimburses the patient, not the provider.

Out-of-network providers record the services they provide and the patient’s payment. This helps the patient submit a claim and get reimbursed. Again, the insurer can only reimburse a patient for services they have already paid for. 

​

Which specialists typically issue superbills?

Many types of healthcare providers use superbills for at least part of their practice. These include but are not limited to: 

• Physical Therapists 

• Counselors

• Clinical social workers

• Psychologists and psychiatrists

• Speech language pathologists

• Lab testing clinics

• Pain management clinics

• Dietitians 

• Dermatologists 

• Plastic surgeons

• Dentists

• Orthodontists 

• Optometrists and ophthalmologists

• Midwives

• Obstetricians

• Family physicians

• Lactation specialists

• Fertility clinics

• Therapists

• Occupational therapists

• Chiropractors

• Podiatrists

• Massage therapists

• Acupuncturists

• Physicians and physician assistants 

• Nurse practitioners

• Pharmacists 

The most common OON providers issuing superbills are therapists. SuperBill works with plenty of physical therapist practitioners, so they are no strangers to therapy reimbursement.

​

What’s Next? 

We hope this post clarifies how superbills work. The one thing knowledge can't help though, is waiting on hold with insurers. If your therapist is spending hours on the phone with insurers, navigating tedious questions like these, they are wasting their time and you're time! 

​

Resource/Citation: https://www.thesuperbill.com/blog/what-is-a-superbill

​