Submitting a superbill to insurance is simpler than it looks, but the process has specific steps that, if skipped, delay or eliminate your reimbursement. Here is the complete process from getting the superbill to receiving your check.
Step 1: Get a Complete Superbill From Your Therapist
Before submitting anything, confirm your superbill includes all required fields. Missing a single field is the most common reason claims are rejected:
- Provider name, NPI, EIN/Tax ID, license number, and practice address
- Your name, date of birth, and insurance member ID
- Date of service
- CPT procedure code (e.g., 90837) and description
- ICD-10 diagnosis code (e.g., F41.1)
- Place of service code (11 for office; 10 for telehealth at home)
- Fee charged and amount paid by you
Step 2: Call Member Services to Confirm the OON Process
Before mailing anything, call the member services number on your insurance card and ask:
- Does my plan cover out-of-network mental health benefits?
- How do I submit an OON claim — online portal, mail, or fax?
- Does the plan require its own claim form, or can I submit the superbill directly?
- What is my OON deductible and has any of it been met?
- What is the claims submission address or portal URL?
Some insurers accept the superbill directly; others require you to complete their own claim form (often available on the insurer's website) with the superbill attached.
Step 3: Submit — Mail, Fax, or Online Portal
Most insurers offer at least one of these methods:
- Online portal — Log in to your member account, find "Submit a Claim," upload the superbill PDF. Fastest and provides a confirmation number.
- Mail — Send to the claims address (not the general correspondence address). Keep a copy and use certified mail if the amount is significant.
- Fax — Some insurers still accept claims by fax. Retain the fax confirmation sheet.
Step 4: Wait (30–45 Days Is Typical)
Most insurers process OON claims within 30 days, though some take up to 45 days. You will receive an Explanation of Benefits (EOB) in the mail or in your online portal first, followed by a check or direct deposit.
Step 5: Review Your EOB
When the EOB arrives, verify:
- The dates of service match the sessions you submitted
- The CPT and ICD-10 codes were processed correctly
- The plan paid the expected percentage of the allowed amount
- The deductible and coinsurance amounts align with your plan documents
Step 6: Follow Up if No Payment or Wrong Amount
Call member services with your claim number (from the EOB) if you see an unexpected denial, low payment, or no response after 45 days. Have the superbill in hand when you call.
Step 7: Appeal if Denied
A denial is not final. You have the right to a formal appeal — and most denials based on clerical errors (wrong code, missing field) are resolved at the first appeal level. Reference the claim number and denial reason code from the EOB in your appeal letter.
Common Mistakes That Cause Delays
- Submitting without a complete superbill (missing NPI or diagnosis code)
- Using the wrong mailing address (general correspondence vs. claims address)
- Submitting after the filing deadline (most plans require submission within 90–365 days of service)
- Failing to attach a required claim form alongside the superbill