Before we get into what a super bill is, we first have to talk a bit about health insurance and how that works.
Almost all health insurances are required to cover specific essential health benefits, like counseling, due to the passing of the Affordable Care Act in 2010. When a counselor is credentialed (or paneled) with your insurance, that means that the insurance has accepted them as a provider and will possibly pay for a portion of your counseling (this is referred to as being in-network, typically). I write ‘possibly’ pay for a portion of your counseling because it genuinely depends on what your insurance benefits are regarding mental health treatment. When a counselor does not accept your insurance then they are referred to as being out-of-network (or outside-of-network). Insurance companies may cover out-of-network (OON) fees once certain requirements have been met. The coverage and the requirements varies per insurance.
Sometimes there may be a particular counselor you might want to work with who does not accept your insurance (meaning they are not credentialed/paneled with your insurance). This means that the counselor cannot bill your insurance company to pay for your sessions, and if you choose to work with this counselor, you are fully responsible for the fees involved. This is when the super bill comes in!
Payment for counseling is required at the time of services. This means that you, the client, will be required to pay for your counseling session at the time of the session. Bitterroot Counseling can provide you a super bill at the end of the month, which is a receipt that shows what counseling services you have received and the cost that you have paid out-of-pocket (your own money). You can then submit this to your insurance for reimbursement (meaning that insurance might pay you back a portion of what you have paid).
Each insurance is very specific about when they will reimburse for out-of-pocket fees. Some require you to hit your deductible maximum, or your out-of-pocket maximum, before they reimburse for a portion of the cost. The portion varies. Some require that the service be pre-authorized (meaning that your insurance approves that you require this treatment and that it is medically necessary). This information should be explicitly detailed in the explanation of benefits that should be provided to you each year around the time of your insurance renewal or sign-up. You can also call and check this information with your insurance directly using the phone number on your card.
Here’s an example:
Let’s say John Doe has four sessions in a typical month with a counselor who is out-of-network. He pays $125 per session. At the end of the month, he will have paid his counselor $500. His counselor will provide him with a super bill (receipt). John Doe will then send this to his insurance. If his insurance covers 50% of out-of-network costs, this means that his insurance will pay John Doe $250. This means that the counselor will have received $500 from John Doe, John Doe will have spent $500 and received $250 (Total $250 spent overall after receiving reimbursement), and his insurance will have spent $250 paying John Doe.
A second example, with a superbill attached:
This is what a super bill looks like. You can see here that John Doe only had two sessions for a total of $250 out-of-pocket fees. This means that Emily Rosson, LPC will have received $250 from John Doe, John Doe will have spent $250 and received $125 (total $125 spent overall after receiving insurance reimbursement), and his insurance will have spent $125 paying John Doe.
Some information has been redacted, and this is an example of the fake client John Doe. You can see that the super bill states:
where the receipt is from
who it is for
who the client is
who the provider is
the name of where the provider works
diagnosis
dates of services
services provided (those 5-digit numbers are called CPT codes, and we'll get into them at a later time)
the description of the service provided
how much was charged
how much was paid
and the total.
It also includes that any payments from this receipt (which the client gives to their insurance) should be made to John Doe.
Some people do not want to get a super bill because it informs their insurance of their mental health care needs and diagnosis. They would prefer to pay completely out-of-pocket (self-pay) to avoid insurance being involved in their treatment.
It is important that you are aware that you retain the right to involve, or to not involve, insurance in your treatment. You always maintain the right to not use your out-of-network insurance coverage and utilize self-pay if you prefer to avoid involving your health insurance in your treatment.
Bitterroot Counseling, LLC is not currently credentialed with any insurance plans. This means that you can request a super bill for out-of-network reimbursement OR that you can use self-pay and avoid having health insurance involved in your treatment.
Update 9/13/2022: Bitterroot Counseling now accepts a few insurance plans. This means that an available option to you, in addition to the super bill and the self-pay, is that you can utilize your in-network insurance benefits.
Sources:
The Common Wealth Fund (2020, April 3). The ACA at 10: How Has It Impacted Mental Health Care? Retrieved August 13, 2022 from https://www.commonwealthfund.org/blog/2020/aca-10-how-has-it-impacted-mental-health-care#:~:text=After%20the%20Affordable%20Care%20Act&text=The%20ACA%20also%20guaranteed%20access,mental%20health%20and%20prescription%20drugs.
U.S. Centers for Medicare & Medicaid Services (n.d.). Preauthorization - Glossary. Healthcare.gov. Retrieved August 13, 2022, from https://www.healthcare.gov/glossary/preauthorization/
U.S. Department of Health & Human Services (2019, February 25). Does the Affordable Care Act cover individuals with mental health problems? HHS.gov. Retrieved August 13, 2022 from https://www.hhs.gov/answers/health-insurance-reform/does-the-aca-cover-individuals-with-mental-health-problems/index.html