How a Superbill Works: Getting Reimbursed for Out-of-Network Therapy

You found a therapist who is a genuinely good clinical fit — the right specialization, the right approach, speaks your language, understands your cultural context. And they’re not in-network with your insurance. Before you walk away from the fit that matters most to your actual healing, it’s worth understanding the superbill. Because depending on your plan, you may be able to get significant money back from your insurer anyway.

What a Superbill Is

A superbill is an itemized receipt — technically a detailed statement of professional services — that contains all the information an insurance company needs to process a claim for out-of-network mental health services. Unlike a standard receipt that just shows what you paid, a superbill includes the therapist’s name, credentials, and National Provider Identifier (NPI) number; your name, date of birth, and insurance member ID; the date and duration of each session; CPT codes identifying the type of service; and ICD-10 diagnosis codes specifying the clinical diagnosis associated with the treatment. With that document, you submit a claim directly to your insurance company and, if your plan has out-of-network mental health benefits, the insurer reimburses you a percentage of what they define as a reasonable rate for that service in your area.

How Much Can You Actually Get Back

This varies considerably by plan. Common structures include 70/30 coinsurance after deductible — you pay 30 percent of the insurer’s “usual, customary, and reasonable” rate, the insurer pays 70 percent; 50/50 coinsurance, more common in ACA marketplace plans with limited out-of-network coverage; and flat dollar reimbursement where some plans pay a fixed amount per session regardless of what was paid. Plans that are HMO or EPO structured typically provide no out-of-network coverage at all. Knowing your plan type before assuming reimbursement is possible saves frustration.

One thing worth knowing: the insurer sets the “reasonable rate” for your area independently, and it may be lower than what the therapist actually charges. So even at 70/30, you may not recover the full difference between the session rate and the in-network copay — but partial reimbursement is often still meaningful, particularly if you’re in sessions weekly.

The Step-by-Step Process

Request the superbill from your therapist — most provide them monthly, though per-session requests are also standard. At Xola Counseling, superbills are provided to all private pay and out-of-network clients upon request. Get the member claim form from your insurer, available for download on your member portal — Aetna and Cigna both have these online under the claims section. Attach the superbill to the completed form and submit by mail, portal upload, or in some cases via the insurer’s mobile app. Allow 30 to 45 business days for processing. Review the Explanation of Benefits (EOB) when it arrives — this document explains what was reimbursed, what was applied to your deductible, and what wasn’t covered. If you believe the determination is wrong, you have the right to appeal and it’s worth doing.

The Deductible Factor

If you have an unmet deductible, you’ll pay the full session cost until that threshold is reached, after which reimbursement kicks in. Superbill claims submitted before your deductible is met still count toward it — so early in the year it may feel like submitting isn’t worth it, but it is. The math works out better than it appears at first.

If your plan is one of the plans Xola Counseling is in-network with — Aetna, Cigna, Quest Behavioral Health, Carelon Behavioral Health, or United Healthcare — none of the above applies. Sessions are billed directly and you pay only your copay at the time of service. Full pricing and insurance detail is on the pricing page. And if you want the full insurance walkthrough specifically for Aetna and Cigna, that post covers it in detail.