Superbill

For your clients

How clients submit out-of-network therapy claims, step by step

With an out-of-network therapist, the client is the one who files the claim. This is the process from the first benefits call to the Explanation of Benefits, written so you can share it with clients.

Quick answer

To get out-of-network reimbursement for therapy, the client files the claim, not the therapist: confirm the plan has out-of-network outpatient mental health benefits, get a superbill from the therapist, complete the insurer’s member claim form, submit both through the portal, by mail or by fax, then read the Explanation of Benefits. The plan pays based on its allowed amount, after the out-of-network deductible and coinsurance.

Updated · Sources are listed at the end of the page.

Last reviewed October 2026. General information for out-of-network therapists, not legal or billing advice. Payer rules change — confirm with the payer before you bill.

Who files the claim

An in-network therapist bills the plan directly. An out-of-network therapist usually does not: the client pays the session fee, the therapist provides a superbill, and the client asks their plan for reimbursement. Any payment normally goes to the client.

How the plan works out the payment

Plans do not reimburse a share of the therapist’s fee. They start from their allowed amount, which HealthCare.gov defines as the maximum a plan will pay for a covered service. The out-of-network deductible is applied first, then the client’s out-of-network coinsurance.

If the fee is higher than the allowed amount, the difference is the client’s. HealthCare.gov’s example of balance billing: a $100 charge with a $70 allowed amount leaves $30 that the provider may bill. For superbills, that gap is already paid by the client and is not reimbursed.

Deadlines that apply

Each plan sets a filing deadline for claims, counted from the date of service. Submitting monthly keeps everyone well inside it. Confirm with the payer when sessions are older than a few months.

For employer plans covered by ERISA, 29 CFR 2560.503-1 sets the plan’s side of the clock: a decision on a post-service claim within a reasonable period and no later than 30 days after the plan receives it (one 15-day extension is possible), and at least 180 days to appeal a denial. Government, church and individual-market plans follow their own rules.

If the claim comes back denied

Read the reason on the Explanation of Benefits. Many denials are fixable without an appeal: a missing NPI, a telehealth line billed with the office place of service, a name that does not match the member record, or a diagnosis pointer that points nowhere. Fix the superbill and resubmit.

If the plan disagrees about coverage, the client can file an internal appeal, and in many cases request an external review after that. HealthCare.gov explains both steps.

What the therapist can do to help

Issue complete superbills on a predictable schedule, with every session on its own line and codes that match the record. Give clients a short written guide to the steps above. Superbill can generate a one-page client submission guide alongside the superbill, free on every plan.

The app only sends your license key and a device id to our license check (which asks Creem) — no patient or practice data ever leaves your browser.

Submit an out-of-network therapy claim

  1. Call the plan or check the member portal: ask about out-of-network outpatient mental health benefits, the deductible, coinsurance, how the allowed amount is set, any pre-authorization, and the filing deadline.
  2. Get a superbill from the therapist for each session, or one per month with every session on its own line.
  3. Download the plan’s member claim form and fill in the member section: name, date of birth, member ID and policyholder.
  4. Submit the form with the superbill through the member portal, by mail or by fax, and keep copies of everything sent.
  5. Read the Explanation of Benefits: the allowed amount, what went to the deductible, the coinsurance, and what the plan paid.
  6. If the claim is denied or reduced, correct and resubmit a fixable error, or file an appeal before the plan’s deadline.

Frequently asked questions

How long does out-of-network reimbursement take?

It depends on the plan. For employer plans covered by ERISA, the plan must decide a post-service claim within 30 days of receiving it, with one possible 15-day extension. Payment timing after approval varies.

Can the therapist submit the claim for the client?

Some out-of-network therapists offer courtesy billing, but it is optional and the arrangement varies. Without it, the client submits the superbill with the plan’s member claim form.

What the free check catches

  • CPT vs. session length (90832 = 16–37 min, 90834 = 38–52, 90837 = 53+; these codes require at least 16 minutes)
  • Telehealth POS 02 / 10 vs. POS 11, and modifier 95 pairing
  • Diagnosis pointers A–D that don’t resolve to a code on the client
  • NPI format and check digit, TIN, member ID, units, signatures
  • DOS age against the 60 / 90 day timely-filing warnings
Make a free superbill

Sources