How Superbills and Insurance Reimbursement Work

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Bright Future Psychology is a self-pay practice providing psychological and psychoeducational evaluations for children, adolescents, and adults in Naples and throughout Southwest Florida.

We do not bill insurance plans directly. However, after services have been completed and paid for, we can provide you with a superbill that you may submit to your insurance company for possible out-of-network reimbursement.

Many insurance plans include out-of-network benefits for psychological services. Coverage differs from one plan to another, so we encourage families to contact their insurance provider before beginning an evaluation.

A superbill is a detailed receipt containing information an insurance company may need to process an out-of-network claim.

A superbill generally includes:

• The client’s identifying information
• The provider’s name, credentials, license information, and National Provider Identifier
• Dates of service
• Relevant diagnostic information
• Current Procedural Terminology, or CPT, codes
• The number of units provided for each service
• The amount charged
• Confirmation that the services were paid for

A superbill is not a guarantee of reimbursement. Your insurance company determines whether services are covered and how much it will reimburse according to the terms of your individual plan.

With an in-network provider, the provider has an agreement with the insurance company and generally submits claims directly. Depending on the plan, the client may be responsible for a copay, deductible, coinsurance, or a combination of these costs.

Bright Future Psychology operates as an out-of-network, self-pay practice. This means:

1. You pay Bright Future Psychology directly for the evaluation.
2. We provide a detailed superbill after the applicable services have been completed and paid for.
3. You submit the superbill and any required claim form to your insurance company.
4. Your insurance company reviews the claim.
5. If your plan includes applicable out-of-network benefits, the insurance company may reimburse you directly.

Some plans allow claims to be submitted through an online member portal or mobile application. Others may request that claims be mailed or faxed.

Insurance terminology can feel confusing. These are the most common terms to know.

A deductible is the amount you are responsible for paying before your insurance benefits begin contributing to covered services.

Plans may have separate deductibles for in-network and out-of-network services. When speaking with your insurance provider, ask specifically about your out-of-network deductible and how much of it you have already met.

A copay is a fixed amount you pay for a covered service, such as $30 for an appointment. Copays are most commonly associated with in-network services, although plan designs vary.

Coinsurance is the percentage of a covered service that you and your insurance company each pay after the applicable deductible has been met.

For example, a plan with 80% out-of-network reimbursement may pay 80% of the amount it recognizes for a covered service, while the member is responsible for the remaining 20%.

A diagnostic evaluation at Bright Future Psychology costs $1,700. Imagine that your insurance plan recognizes the full $1,700 evaluation fee, you have $200 remaining on your out-of-network deductible, and your plan reimburses 80% after the deductible is met.

The first $200 completes your deductible, leaving $1,500. The insurance plan reimburses 80% of $1,500, which equals $1,200.

In this example, you would receive $1,200 back from your insurance company.

This is only an illustration of how reimbursement might work. Actual reimbursement depends on your plan’s benefits, deductible, coverage policies, and processing of each CPT code.

Every evaluation is individualized. The final combination of services, measures, time, CPT codes, and units depends on the referral questions and the client’s needs.

Estimated fee: $1,700

Estimated total time: Approximately 8 hours

Typical focus: One focused diagnostic question, such as ADHD, ASD, and dyslexia.

Estimated fee: $2,400

Estimated total time: Approximately 12 hours

Typical focus: Two related diagnostic questions, such as autism and ADHD.

Estimated fee: $3,500

Estimated total time: Approximately 17 hours

Typical focus: A broader cognitive, academic, emotional, behavioral, developmental, and diagnostic assessment.

Time estimates include approximately 30 minutes for the initial intake. Individual needs, records, measures, clinical questions, and testing circumstances may change the final time and units.

We will discuss the recommended evaluation and estimated fee with you before services begin.

CPT codes describe the professional services provided during an evaluation. They may represent interviewing, test administration, scoring, interpretation, integration of results, report preparation, clinical planning, and feedback.

Billing unit: Untimed

Our fee: $200

This code represents the first period of test administration and scoring performed by a psychologist.

Billing unit: First 30 minutes

Our fee: $100

This code represents additional periods of test administration and scoring.

Billing unit: Each additional 30 minutes

Our fee: $100 per unit

This code includes interpretation, integration of results, clinical planning, report preparation, and feedback.

Billing unit: First hour

Our fee: $200

This code represents additional time for interpretation, integration of results, clinical planning, report preparation, and feedback.

Billing unit: Each additional hour

Our fee: $200 per unit

The codes and units shown here are planning estimates. A superbill must reflect the services that were actually performed and documented.

The following examples may help you discuss potential coverage with your insurance company.

Estimated units:

• CPT 90791: 1 unit
• CPT 96136: 1 unit
• CPT 96137: 2 units
• CPT 96130: 1 unit
• CPT 96131: 5 units

Estimated units:

• CPT 90791: 1 unit
• CPT 96136: 1 unit
• CPT 96137: 3 units
• CPT 96130: 1 unit
• CPT 96131: 8 units

Estimated units:

• CPT 90791: 1 unit
• CPT 96136: 1 unit
• CPT 96137: 6 units
• CPT 96130: 1 unit
• CPT 96131: 12 units

These estimates are intended to help families discuss coverage with their insurance companies. The final codes and units may differ because every evaluation is tailored to the individual.

Before calling, have your insurance card and a way to take notes available. Ask to speak with a representative about outpatient, out-of-network mental health benefits for psychological testing and evaluation services.

You may use the following questions:

• Does my plan include out-of-network benefits for psychological testing and evaluation?
• What is my out-of-network deductible?
• How much of that deductible have I already met?
• What percentage does the plan reimburse after the deductible is met?
• How does the plan process CPT codes 90791, 96130, 96131, 96136, and 96137?
• Are there limits on the number of units covered for any of these CPT codes?
• Does the plan reimburse based on the provider’s fee or another amount established by the plan?
• Is there a separate claim form I need to submit with the superbill?
• Can I submit the claim through my online member portal?
• What is the deadline for submitting an out-of-network claim?
• What supporting documentation, if any, should accompany the superbill?

It can also be helpful to record:

• The date of your call
• The representative’s name
• A reference number for the conversation
• The benefits and instructions provided

Information given by an insurance representative is not always a guarantee that a claim will be approved, but asking these questions can help you better understand your benefits and prepare for the submission process.

After receiving your superbill:

1. Review it to make sure your name and identifying information are correct.
2. Obtain your insurance company’s out-of-network claim form, if one is required.
3. Complete the member section of the form.
4. Attach the superbill and any other requested documents.
5. Submit everything through the insurance portal or by the method provided by your plan.
6. Save copies of all documents for your records.
7. Monitor your insurance portal or Explanation of Benefits for updates.

If the insurance company requests additional clinical records, please contact us before sending anything. We will help determine what documentation is appropriate and obtain any necessary authorization.

Bright Future Psychology is a self-pay practice and does not bill insurance directly. We can provide a superbill that clients may submit for possible out-of-network reimbursement.

Many plans include out-of-network benefits, but reimbursement is determined by the individual insurance company and plan. Contact your insurance provider before beginning the evaluation to learn about your benefits.

Superbills are provided after the applicable services have been completed and paid for. The superbill must accurately reflect the services and units provided.

Generally, a superbill is created after services have been performed. Because evaluation codes and units must correspond to actual completed services, the final superbill cannot be prepared in advance.

Insurance companies calculate reimbursement according to each member’s plan, deductible, coverage policies, and processing of CPT codes. Bright Future Psychology cannot determine or guarantee the amount, but this guide can help you ask your insurance provider the appropriate questions.

Bright Future Psychology is an approved Step Up for Students provider. Eligible families may be able to use FES-UA or PEP scholarship funds for qualifying services. Please contact us to discuss your circumstances and current program requirements.

Our downloadable Superbill and Insurance Reimbursement Guide includes the CPT codes, estimated fees, units, insurance questions, and reimbursement example in a convenient format you can save or use while speaking with your insurance company.

Choosing an evaluation is an important decision. Our team is happy to answer questions about the evaluation process, help you understand the available evaluation options, and provide a clear fee estimate before services begin.

You may also call (239) 326-3580 or email info@brightfuturepsychology.com.

This information is provided for general educational purposes and is not a guarantee of insurance coverage or reimbursement. Benefits and claims decisions are determined by the individual insurance company and plan.