Superbills and Out-of-Network Benefits

What a Superbill Is

A superbill is an itemized statement of the sessions you attended and the fee for each one. Despite the name, it is a record of your sessions, not an extra charge. You submit it to your plan yourself when you ask to be paid back for out-of-network care. Marie can provide one each month, covering that month's sessions. Keep a copy of every superbill you send, so you have your own record if a question comes up later.

What Out-of-Network Means

A plan's network is the group of providers it has agreements with, and a provider outside that group is out-of-network. When you see an out-of-network therapist, you may pay the full fee yourself and then ask your plan to pay back part of it, depending on your benefits. PPO plans may include out-of-network benefits, but the details differ from plan to plan. Your plan, not Marie, decides whether to reimburse you and how much.

Questions to Ask Your Plan First

Before your first session, call your plan or check your benefits summary and ask a few direct questions. Ask whether you have outpatient mental health benefits and whether the plan reimburses out-of-network outpatient care. Ask what your deductible is and whether it has been met, how many sessions per year the plan covers, and what the coverage amount per session is. Also ask whether approval from your primary care physician is required. Note each answer and the date.

After You Submit a Superbill

Once a superbill reaches your plan, the plan applies its own rules. If your deductible has not been met, your sessions may count toward it before anything is paid back. After that, the plan may reimburse part of each session fee, up to its own limits. Neither Marie nor this guide can tell you what your plan will pay; only the plan can. If a payment looks different from what you expected, ask the plan to explain how it was worked out.

Fees, Payment, and Next Steps

Individual therapy is $200 and couples or family therapy is $225, each for a 50-minute session. Payment details are covered on the free 15-minute consultation, where superbill questions are welcome too. Marie asks for at least 48 hours' notice to cancel. If you pay privately, you also have the right to a Good Faith Estimate, explained in its own guide. Sessions are online for clients located in Oregon or in person at 1125 SE Market St, Portland, OR 97214.

Questions You May Have