Last Updated on August 17, 2026 by Dr. Alan Jacobson
Working with an out-of-network therapist doesn't mean paying full price with nothing back. A superbill is the document that turns your sessions into a legitimate insurance reimbursement claim — here's exactly how it works.
One of the most common questions I hear during a first consultation is some version of: "You don't take my insurance — so is this actually going to cost me full price?" For many clients, the honest answer is no. As an out-of-network provider, I don't bill your insurance directly, but I do provide a superbill — a detailed, insurance-ready receipt you submit yourself for potential partial reimbursement. This guide walks through exactly what that process looks like, what you're legally entitled to, and how to avoid the most common reasons reimbursement claims get delayed or denied.
In this article
What a Superbill Actually Is
A superbill is an itemized receipt that an out-of-network provider gives you so you can submit a reimbursement claim directly to your own insurance company. Unlike in-network billing, where the therapist's office handles claims submission for you, out-of-network reimbursement puts you in the driver's seat: you pay the full session fee upfront, then submit the superbill yourself (or through a claims-filing app) to request partial reimbursement based on your specific out-of-network benefits.
This isn't a workaround or a loophole — it's a standard, well-established part of how out-of-network healthcare billing works across mental health and medicine generally.
What's Actually on a Superbill
For a superbill to be processed, it needs to include the specific information your insurer's claims system requires:
- Provider information — name, license type and number, National Provider Identifier (NPI), and practice address
- CPT procedure code — the billing code for your session type (for example, 90837 for a 53+ minute individual psychotherapy session)
- ICD-10 diagnosis code — insurers only reimburse for medically necessary care, which requires a diagnosis on file
- Dates of service — each session date, billed individually
- Charges and payments — the fee for each session and what you paid
A diagnosis code is a required part of this process for any mental health superbill, not something specific to my practice — insurance companies need it to determine medical necessity before reimbursing anything.
Step-by-Step: Getting Reimbursed
Call your insurer before your first session
Ask specifically about your "out-of-network outpatient mental health" benefits — not just general out-of-network coverage, since mental health can sometimes be handled by a separate behavioral health administrator.
Request your superbill
We provide a superbill you can request after your sessions — many clients request theirs monthly to keep the submission process manageable.
Submit it to your insurer
Most insurers accept submissions through an online member portal, a mobile app, or by mail with a simple claim form attached.
Track your deductible
Most out-of-network benefits don't kick in until you've met a separate out-of-network deductible — track your running total so you know when reimbursement should start.
Follow up if needed
Claims can take several weeks to process. If you haven't heard back, a quick call to your insurer with your claim number usually gets things moving.
How Much Will You Actually Get Back?
Reimbursement amounts vary considerably by plan, and insurers typically reimburse based on their own "allowed amount" for your CPT code — which may be lower than what you actually paid — rather than the full billed fee. Peterson-KFF Health System Tracker's analysis of large employer health plans found meaningful out-of-network utilization for mental health and substance use care specifically, underscoring that this is a common, expected part of how many people access care outside their network (Peterson-KFF Health System Tracker).
Your Legal Protections
Good Faith Estimate (No Surprises Act)
Federal law requires that uninsured and out-of-network clients receive a written Good Faith Estimate of expected costs before care begins. If your actual bill ends up at least $400 higher than the estimate, you have the right to dispute it (CMS, No Surprises Act).
Mental Health Parity Act
If your health plan covers out-of-network benefits for medical or surgical care, federal law requires it to offer comparable out-of-network benefits for mental health and substance use care — insurers cannot apply stricter limits to mental health coverage than to physical health coverage (CMS, MHPAEA; U.S. Department of Labor).
You can find our current Good Faith Estimate practices on our Fees & Insurance section and our Practice Policies page.
Is Therapy HSA/FSA Eligible?
In most cases, yes. According to IRS Publication 502, the cost of psychotherapy and counseling qualifies as an eligible medical expense when it's intended to diagnose, treat, or manage a condition — which describes the large majority of individual therapy (IRS Publication 502). We accept FSA and HSA cards directly as payment, and your superbill can also serve as documentation if your plan administrator requests it. We recommend confirming your specific plan's requirements with your administrator, since some plans request a letter of medical necessity for certain situations.
Questions to ask your insurer before your first session
- "Do I have out-of-network benefits for outpatient mental health services?"
- "What is my out-of-network deductible, and how much have I met this year?"
- "What is your allowed amount for CPT code 90837, and what percentage do you reimburse?"
- "How do I submit a superbill — through a portal, app, or mail?"
- "Is there a limit on the number of sessions covered per year?"
Still not sure what your plan actually covers?
A free 20-minute consultation is a good place to ask questions about fees, superbills, and what to expect — no pressure, no obligation.
Schedule a Free Consult Read Therapy FAQsFrequently Asked Questions
Do I need a diagnosis to get a superbill?
Yes. Insurance companies require a diagnosis code to determine medical necessity before reimbursing any claim, so a diagnosis is a standard part of every mental health superbill, regardless of provider.
Is my reimbursement guaranteed?
No. Reimbursement depends entirely on your specific insurance plan's out-of-network benefits, deductible status, and allowed amounts. We recommend contacting your insurer directly before your first session to get an accurate picture of what to expect.
What if my insurance denies the claim?
Common reasons include an unmet out-of-network deductible, a plan that excludes out-of-network mental health benefits entirely, or missing information on the claim form. If you believe a denial is incorrect, you can request a written explanation and, in some cases, file an appeal directly with your insurer.
Can I use an app to submit superbills instead of doing it myself?
Yes. Several third-party services exist specifically to submit superbills and track reimbursement on your behalf for a fee. Many clients also submit directly through their insurer's member portal at no additional cost.
Does a superbill affect my privacy the way in-network billing might?
A superbill includes a diagnosis code, which becomes part of the claims record your insurer maintains, similar to in-network billing. If privacy from your insurer is a significant concern, this is worth discussing during your consultation.
Will you help me understand my Good Faith Estimate?
Yes. Federal law requires we provide a Good Faith Estimate of expected costs before your first appointment, and we're happy to walk through it with you and answer any questions.
Sources & Further Reading
- Centers for Medicare & Medicaid Services. "No Surprises Act: Overview of Key Consumer Protections."
- Centers for Medicare & Medicaid Services. "The Mental Health Parity and Addiction Equity Act (MHPAEA)."
- U.S. Department of Labor. "Know Your Rights: Parity for Mental Health and Substance Use Disorder Benefits."
- Internal Revenue Service. Publication 502, Medical and Dental Expenses.
- Peterson-KFF Health System Tracker. "An Analysis of Out-of-Network Claims in Large Employer Health Plans."
This article is for general informational purposes and is not a substitute for confirming your specific benefits directly with your insurance provider.
Alan Jacobson, Psy.D., MBA, is a licensed clinical psychologist and Director of the Foresight Psychological Institute.
