Finding a therapist is an important step, but figuring out how to pay for therapy can sometimes feel just as complicated.
You may have health insurance but discover that the therapist you want to see is considered out-of-network. Or perhaps you are interested in a therapist who does not bill your insurance company directly.
That does not necessarily mean you have to give up on the therapist you want.
Depending on your health insurance plan, you may have out-of-network mental health benefits that allow you to submit documentation for reimbursement. One document you may receive from your therapist is called a superbill.
If you have never used one before, the process can sound confusing. What is a superbill? What information does it contain? How do you submit it? Will your insurance company reimburse you?
This guide walks through the process and explains what to ask your insurance company before beginning therapy.
What Is a Superbill for Therapy?
A superbill is an itemized document that summarizes healthcare services you received from a provider.
For therapy, a superbill may include information such as:
- The therapist’s name and professional credentials
- Provider information
- The date of the therapy appointment
- The type of service provided
- Relevant billing or procedure codes
- The amount charged
- The amount paid
- Other information needed by an insurance company to process a claim
A superbill is generally not the same thing as a traditional bill.
Instead, it can provide the information your insurance company needs when you are submitting an out-of-network claim yourself.
The exact information included on a superbill can vary depending on the provider, service, and billing requirements.
What Does “Out-of-Network” Mean?
Health insurance companies generally have networks of healthcare providers who have contracted with the insurance company.
When a provider is in-network, they have an agreement with the insurance company regarding reimbursement and billing.
An out-of-network provider does not have that same contractual relationship with your insurance company.
This does not automatically mean that your insurance will not pay anything toward the service.
Some insurance plans include out-of-network benefits, while others may not.
For example, your insurance plan might cover a portion of eligible out-of-network mental health services after you meet a deductible.
Another plan may provide no out-of-network reimbursement at all.
That is why checking your benefits before starting therapy is important.
Does Insurance Reimburse Out-of-Network Therapy?
It depends on your individual insurance plan.
There is no universal rule that says every insurance company or plan will reimburse out-of-network therapy.
Before assuming that a superbill will result in reimbursement, contact your insurance company and ask specifically about your mental health benefits.
Some important questions include:
- Does my plan include out-of-network mental health benefits?
- Does my plan cover outpatient psychotherapy?
- What is my out-of-network deductible?
- How much of my deductible have I already met?
- What percentage of the allowed amount is reimbursed after my deductible?
- Is there a maximum reimbursement amount?
- Does the plan have a separate mental health deductible?
- Do I need prior authorization?
- Do I need a referral from my primary care provider?
- How do I submit an out-of-network mental health claim?
- Can I submit a superbill electronically?
- How long does reimbursement typically take?
- Are telehealth therapy sessions covered?
- Are there any restrictions based on where the therapist is licensed?
Keep in mind that insurance policies can differ substantially, even when two people have insurance from the same company.
Step 1: Check Your Out-of-Network Mental Health Benefits
Before Starting Therapy, Ask Your Insurance Company:
- Do I have out-of-network mental health benefits?
- What is my out-of-network deductible?
- How much of my deductible have I already met?
- What percentage of eligible out-of-network therapy costs is reimbursed?
- Is there a maximum reimbursement amount?
- Do I need prior authorization or a referral?
- Are telehealth therapy sessions covered?
- How do I submit an out-of-network claim or superbill?
Tip: Write down the representative’s name, the date you called, and any reference or confirmation number they provide. Insurance benefits can vary by plan, so getting confirmation directly from your insurance company can help you understand your potential out-of-pocket costs.
Step 2: Ask How Much You May Actually Pay
One of the most important questions to ask is not simply:
“Does my insurance cover therapy?”
Instead, ask:
“What will my out-of-pocket cost be for an out-of-network mental health visit?”
These are not necessarily the same question.
For example, an insurance company may say that it reimburses a percentage of eligible out-of-network services. However, that percentage may apply only after you have met your deductible and may be calculated using the insurer’s allowed amount rather than the therapist’s full fee.
You should therefore ask your insurance company how reimbursement is calculated.
Do not assume that you will receive a specific percentage of the amount you pay your therapist.
Step 3: Ask Whether Telehealth Therapy Is Covered
Virtual therapy has become an important option for people who want professional support without traveling to an office.
If you are considering online therapy, ask your insurance company whether your plan provides out-of-network benefits for telehealth mental health services.
You can also ask:
- Are virtual therapy sessions covered?
- Are there different rules for telehealth?
- Does the therapist need to be licensed in a specific state?
- Does the therapist need to meet any additional requirements?
- Is there a different reimbursement rate for virtual services?
This is especially important when choosing a therapist who provides services virtually.
Step 4: Receive Your Superbill
If you receive therapy from a provider who gives you superbills, the document may contain the information needed for you to submit an out-of-network claim.
Keep your superbills and payment records organized.
You may want to create a folder specifically for therapy-related insurance documents.
Depending on your insurance company’s requirements, you may need to submit:
- The superbill
- A claim form
- Proof of payment
- Other supporting information
Always follow your insurance company’s instructions.
Step 5: Submit the Superbill to Your Insurance Company
Your insurance company should be able to tell you how to submit an out-of-network claim.
Some insurers allow online submission through a member portal. Others may require a paper claim form.
Before submitting anything, check:
- That the information on the superbill is accurate
- That the date of service is correct
- That the provider information is correct
- That the amount paid is documented correctly
- That any required claim form is complete
- That you are submitting through the correct channel
Keep copies of everything you submit.
Step 6: Track Your Claim
After submitting your claim, keep track of its status.
Insurance processing times vary.
If your claim is denied, do not automatically assume that you are ineligible for reimbursement.
Read the explanation from your insurance company and determine why the claim was denied.
You may need to:
- Correct missing information
- Provide additional documentation
- Resubmit the claim
- Ask for clarification
- Appeal the decision if appropriate
Your insurance company can explain its specific process.
What If My Insurance Does Not Cover Out-of-Network Therapy?
If your insurance does not provide out-of-network benefits, you may still have other options.
Depending on your circumstances, you can explore:
- In-network therapists
- Self-pay therapy
- Sliding-scale options
- Lower-cost therapy programs
- Supervised therapy programs
- Other available community mental health resources
The important thing is not to assume that insurance limitations mean therapy is automatically unavailable to you.
Ask the practice about available options and determine what fits your budget.
Can I Use a Superbill for Online Therapy?
Potentially, but the answer depends on your insurance plan and the circumstances of the service.
Online therapy is still healthcare, but insurance coverage for virtual services can vary.
When considering online therapy, ask both the therapist and your insurance company questions about:
- State licensure
- Telehealth coverage
- Out-of-network benefits
- Claim submission
- Reimbursement
- Documentation
For a virtual therapy practice serving multiple states, the therapist’s licensure is particularly important.
Virtual Therapy Across Texas, Ohio, and California
The Empowering Space provides virtual therapy with clinicians licensed in the states they serve.
Our current multi-state coverage can give eligible clients more options when looking for a therapist whose availability and approach fit their needs.
With clinicians licensed in Texas, Ohio, and California, The Empowering Space can support eligible clients across Central, Eastern, and Pacific time zones, depending on the clinician.
This can be especially helpful for people who have demanding schedules, work nontraditional hours, or need more flexibility when looking for therapy.
Availability varies by therapist.
Questions to Ask Before Choosing an Out-of-Network Therapist
Before scheduling, consider asking:
About cost
- What is the session fee?
- Do you offer sliding-scale options?
- Do you provide superbills?
- When will I receive the superbill?
- What payment methods do you accept?
About insurance
- Do you bill insurance directly?
- Are you considered in-network or out-of-network?
- Do you provide documentation for out-of-network reimbursement?
About therapy
- What concerns do you typically work with?
- What therapy approaches do you use?
- Do you provide virtual appointments?
- What days and times are available?
About location
- Which states are you licensed to practice in?
- Can you provide services to someone located in my state?
These questions can help you determine whether a therapist is a practical fit before you begin.
Therapy Should Fit Your Life and Your Budget
Cost is a real consideration when looking for mental health care, but it should not be the only factor.
The right therapist should also be someone you feel comfortable with, whose expertise matches your concerns, and whose availability fits your life.
For some clients, virtual therapy makes it easier to attend appointments without commuting or taking as much time away from work, family, or other responsibilities.
The Empowering Space offers virtual therapy options for eligible clients in Texas, Ohio, and California, with clinicians available across multiple time zones.
Ready to Find a Therapist?
You do not have to figure out the entire therapy process before taking the first step.
If you are looking for virtual therapy, The Empowering Space can help you explore therapist options based on your needs, preferences, location, and availability.
More therapists. More availability. More ways to find the right fit.
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Explore available therapists and find an option that fits your needs and schedule.
Not sure where to start?
Important Note
Insurance benefits vary by plan, employer, provider, and location. The information in this article is educational and should not be considered a guarantee of insurance reimbursement or financial advice.
Before beginning therapy, contact your insurance company directly to confirm your specific benefits, deductibles, reimbursement requirements, and telehealth coverage.
