What is a superbill? (and what to do with one)

What a superbill is

A superbill is an itemized receipt from a provider who does not bill your insurance. It carries the codes and identifiers a payer needs: diagnosis, procedure, date, charge, and the provider’s tax ID and NPI. You submit it yourself and ask to be paid back.

The name is unhelpful. Nothing about the document is super, and in the sense that matters it is not a bill at all. It is a coded summary of care that already happened and that you already paid for, formatted so an insurer can process it as a claim. Most of what is difficult about superbills comes from that. The paperwork was designed for a conversation between a provider and a payer, and you have been handed one end of it.

Two things have to be true before it does anything for you. Your plan has to cover out-of-network care, and the claim has to arrive complete and on time. The rest of this guide is about those two conditions.

What it is not

A superbill sits in the middle of five documents that look similar and do completely different jobs.

The EOB confusion is the expensive one, because the two documents are a matched pair. The superbill is what you send. The Explanation of Benefits is what your plan sends back to say how it handled the claim. You need both to know whether you were paid correctly, and they arrive weeks apart from two different organizations, which is exactly why they get separated.

Why you’re holding one

Most people meet their first superbill in therapy, and the reason is structural. Your therapist is not unusual. A study of 175,083 private-practice psychotherapists published in Health Affairs Scholar (September 2024, data as of December 31, 2023) found that 35.1% do not accept insurance, with mean county-level acceptance rates by state ranging from 41.0% in the District of Columbia to 90.5% in North Dakota. The APA 2024 Practitioner Pulse Survey (December 2024) puts it another way: 34% of practicing psychologists are not in-network with any insurer. Among the 374 respondents who had left panels or never joined, 82% cited insufficient reimbursement and 62% cited administrative burden.

The same study found a mean cash-pay psychotherapy rate of $143.26 per session, rising to $155.90 among providers who do not take insurance (Health Affairs Scholar, September 2024). And the gap shows up in how patients use their plans: commercially insured patients went out-of-network 3.5 times more often for behavioral health than for medical or surgical care, rising to 10.6 times for psychologists and 8.9 times for psychiatrists, in an RTI International analysis of more than 22 million lives from 2019 to 2021, published April 2024 for the Bowman Family Foundation.

So the superbill is not a workaround somebody invented for you. It is the standard exit route from a network that a third of an entire profession has left.

Every field, and why the payer needs it

Below is a sample superbill with the fields a member claim actually turns on. Hover or tap a field to read what it does. The values are illustrative; the meanings are the same on every superbill.

Two of these carry more weight than the rest. The NPI and the tax IDare separate identifiers and a claim generally wants both. Aetna’s member claim form (GC-7, revised June 2025) collects them in different boxes of its physician section, along with diagnosis, dates of service, place of service, procedure code, charges, units, and a physician signature.

Check it before you submit

Insurers publish exactly what they need, and you can read a superbill against that list before you send it. Aetna’s form states, in capital letters, that incomplete claim forms will be returned to you for missing information (Aetna GC-7, June 2025). A returned claim burns weeks of a filing deadline you do not control.

Cigna’s member medical claim form (Rev. 11/2023) lists what an itemized bill must contain. Read your superbill against it line by line:

• Customer name, meaning the subscriber on the policy, and the patient name if they are different people.
• Date of service for every line.
• Procedure code and the charge for that code.
• Professional name and credentials, plus the practice address.
• Tax ID for the practice.
• ICD diagnosis code.

Cigna adds a warning worth reading twice: it cannot accept receipts, balance-due statements, or cancelled checks in place of the itemized bill.A credit card slip from your therapist’s office is not a substitute for a coded document, however clearly it shows the money left your account.

Aetna’s instructions describe a slightly different minimum for an attached bill: patient name, dates, the condition treated, the patient’s relationship to the employee, and the type of service. Requirements are payer-specific, which is why the practical rule is to satisfy the union of both lists. Add the NPI and the provider signature, and you have a document that clears essentially any member claim form.

One honest caveat: no primary source ranks the reasons superbills get rejected by frequency, so treat any page that gives you percentages here with suspicion. What is documented is that incomplete forms come back, and that the two insurers above tell you precisely what complete means.

How to submit it

The superbill is not the claim. It is the attachment. What you file is your insurer’s member medical claim form, sometimes called a subscriber or member reimbursement form. Five steps, in order:

1. Call your plan and confirm out-of-network benefits. Ask whether the plan pays anything out of network, what the out-of-network deductible is, and how much of it you have met this year.
2. Download your plan’s member medical claim form from its member site. It is a different form from the one a provider files, and most plans keep it under claims or forms.
3. Fill it in from your insurance card.Member ID, group number, and the subscriber’s name and date of birth all come off the card, and the subscriber is not always the patient.
4. Run the field check above, then attach the superbill as the itemized bill. This is the step that decides whether the claim is processed or returned.
5. Submit through the portal or by mail, and note the deadline. Insurers call it timely filing: the window, counted from the date of service, in which a claim can still be filed. Cigna gives members 180 days; other plans commonly land somewhere between 90 days and 12 months.

The provider-side equivalent is the CMS-1500, the standard paper claim form maintained by the National Uniform Claim Committee, version 02/12, in effect since April 1, 2014. You generally do not fill one out as a patient. It is worth knowing the name because it is what your superbill’s contents are eventually translated into.

Then watch the deadline, because it is the one thing you cannot fix later. Cigna gives members 180 days from the date of service to file a domestic claim, and 365 days for a foreign one, unless your plan or state law allows more time (Cigna member medical claim form, Rev. 11/2023). Other insurers vary, commonly somewhere between 90 days and 12 months. The clock runs from the date of service, not from the date the superbill was written. We could not verify the current figure for other major carriers from a primary source, so check your own plan documents rather than trusting a number you read anywhere, including here.

There are services that file member claims for you, including Reimbursify, Mentaya, and Thrizer. They charge for the service; we could not confirm current prices, so check before you use one. The thing to compare is the fee against the size of a typical reimbursement in the next section, not against the sticker price of a session.

What you actually get back

Reimbursement is a percentage of a number your plan chooses, not a percentage of what you paid. That is why a first EOB disappoints people.

Your insurer sets an allowed amount, also called the recognized charge or the usual, customary, and reasonable rate (UCR). Formulas vary, and often key off Medicare rates or local price data. Your coinsurance applies to that allowed amount. The gap between your provider’s charge and the allowed amount is yours to absorb, and billing you for that difference, called balance billing, is generally legal when you chose an out-of-network provider on your own (Nebraska Department of Insurance consumer fact sheet, May 2018). The exception is the federal No Surprises Act, effective January 2022, which bans balance billing for emergency care and for certain out-of-network care delivered at in-network facilities.

Here is what that looks like with numbers, using Granite’s worked example.

You pay your provider $150 for a session. Your out-of-network deductible is already met. Your plan sets its allowed amount for that service at $110 and covers 60% of the allowed amount, so it sends you $66. You absorb the remaining $84. That is the system working as designed.

Now run the same session against an unmet deductible. You paid $150, your out-of-network deductible is $1,000, and you have met $400 of it. The plan pays $0 on this claim. What it credits toward the deductible is typically the allowed amount of $110, not the $150 you handed over, which puts you at $510 met rather than $550. That is how plans generally apply out-of-network spending, and it is the same allowed-amount rule working in the other direction.

Filing an unpaid claim is still worth the envelope, because a claim you never file counts toward nothing.

Denials are more common out of network. On HealthCare.gov, insurers denied 37% of out-of-network claims in 2024 against 19% of in-network claims, across 496 million claims from 156 reporting insurers (KFF, published March 2026). Two caveats before you carry that number anywhere: it covers marketplace plans only, not employer coverage, and it counts mostly provider-submitted claims rather than member-submitted superbills. Treat it as a signal about out-of-network claims in general, not as a superbill rejection rate.

Appeals are worth more than their reputation suggests. In the same data, consumers appealed fewer than 1% of denied in-network claims, and insurers upheld their original decision on 66% of those appeals. Both of those figures describe in-network denials, because that is the only slice KFF reports appeal data for (KFF, March 2026). Out-of-network appeal outcomes are not published, so treat the in-network pair as the closest available proxy rather than as your odds on a superbill.

When a superbill gets you nothing

Four situations where the document is real, correct, and still worthless for reimbursement. Check these before you spend an afternoon on paperwork.

• Your plan has no out-of-network benefit.Most HMOs do not cover non-emergency care outside the network, so there is no benefit for the claim to draw on. Plan type decides this, and it is printed on your card. For context on how common each type is: KFF’s 2025 Employer Health Benefits Survey (October 2025) found 46% of covered workers in a PPO, 33% in an HDHP with a savings option, 12% in an HMO, and 9% in a POS plan.
• Your provider opted out of Medicare.When a provider has formally opted out and treats you under a private contract, Medicare will not reimburse either the provider or the beneficiary. An opt-out lasts two years (Noridian, a Medicare Administrative Contractor). A superbill from an opted-out provider is just a receipt. If the provider has not opted out, patient-side reimbursement runs through Medicare’s own process and its own form, not through a superbill you mail in like a commercial member claim.
• You have Medicaid. There is effectively no patient-side out-of-network reimbursement. Enrolled providers accept the Medicaid rate as payment in full, and the program does not pay members back for care bought outside it.
• Your out-of-network deductible is not met. The claim pays $0. File it anyway, because the claim is how the spending gets counted.

The fastest way to find out is a phone call before your next appointment. Ask three questions: does my plan have out-of-network benefits, what is my out-of-network deductible and how much of it is met, and what percentage of the allowed amount does the plan pay. The third answer is the one that predicts your reimbursement.

Telehealth codes, and the one that breaks claims

If your sessions happen over video, two fields on the superbill change, and both are easy to get wrong.

Place of service 11 means the office.Putting it on a telehealth session is a billing error. Place of service 10 is the patient’s home, and 02 is another telehealth location. On the procedure line, modifier 95 flags synchronous audio-video care on most commercial plans, and 93 flags audio-only. Payers differ on which combinations they accept, so this is a question for your specific plan.

You do not have to know the right answer to be useful here. You only have to notice that a session you attended from your kitchen carries an office place-of-service code, and ask your provider about it before the claim goes out.

Therapy specifics, and the diagnosis code trade-off

Four CPT codes cover most outpatient therapy: 90791 for the diagnostic intake, 90834 for a 45-minute session, 90837 for a 60-minute session, and 90847 for family or couples therapy with the patient present. If your superbill lists 90834 for hours you spent in the room, that is worth raising, because the code sets the price the insurer works from.

Then there is the part of a superbill that has nothing to do with money. Reimbursement requires a diagnosis code, and a diagnosis code puts a mental health diagnosis into your insurance claims history. There is no way around that, because it is the mechanism itself: an insurer pays for the treatment of a condition, so it needs the condition named in ICD-10. Some people pay out of pocket and skip the claim to avoid this. Others decide the reimbursement matters more.

Make that decision with real information. Ask your provider which code they intend to use and why, and ask your plan what it does with claims data. It is a legitimate conversation to have before the first superbill is issued, and much harder to unwind afterwards.

A related option worth knowing about: courtesy billing, where the provider files the out-of-network claim for you without accepting assignment. Assignment of benefits is the authorization that tells an insurer to pay the provider directly instead of paying you, so declining it keeps the check pointed at you rather than at the practice. It saves you the paperwork. It carries the same diagnosis exposure, because it is the same claim.

Using a superbill for an HSA or FSA

A superbill is unusually good substantiation, and the reason is written into the rules. IRS Publication 969 (for use in preparing 2025 returns) says a health FSA requires a written statement from an independent third party stating that the medical expense has been incurred and the amount, plus your statement that it has not been reimbursed elsewhere. A coded, dated, signed document from your provider is precisely that.

An HSA works differently, and the difference trips people up:

• You keep the records yourself. Publication 969 tells you to keep records sufficient to show that distributions were used exclusively to pay qualified medical expenses, that the expenses were not previously reimbursed from another source, and that you did not take them as an itemized deduction.
• Do not send those records with your tax return. Keep them with your tax records. The IRS says so directly.
• No double-dipping. An expense you paid with HSA money, or that an insurer reimbursed, cannot also be claimed as a medical deduction on Schedule A.

That last rule is where a superbill can quietly get you into trouble, because one document can end up doing three jobs: proof for the insurer, substantiation for the FSA, and a receipt in a tax folder. You get one or the other. If your plan sends back $66 on a $150 session, the reimbursed portion is not yours to deduct.

One per session, or a batch?

A superbill can carry several dates of service as separate lines, so you are not obliged to file weekly. Practices commonly issue one per month.

Our recommendation: submit monthly, and never let a superbill sit longer than 60 days.Monthly gives you one claim to track instead of four, one EOB to reconcile instead of four, and a short enough loop that a missing NPI or a wrong place-of-service code surfaces while there is still most of a filing window left. Sixty days is the ceiling because the shortest deadline we could verify is Cigna’s 180 days, and a rejected claim needs time to be corrected and refiled inside it.

The failure mode we would avoid is the annual pile: twelve months of superbills submitted in one envelope in December, some of them already past a 180-day deadline, with no EOB yet returned to tell you whether the format was even accepted.

If you never asked for one

A superbill can be written after the fact. Your provider already holds the dates, codes, charges, and payments in their records, so producing one for sessions from six months ago is ordinary records work. The real constraint is your plan’s timely filing deadline, which runs from each date of service rather than from the day the superbill was printed. Old dates can already be dead on arrival while recent ones are still filable, so ask for the whole span and file whatever is still inside the window.

The paper trail a superbill creates

One reimbursement produces three documents, and they arrive at three different times from three different places: the superbill from your provider, the EOB from your insurer, and proof of payment from your bank or card. Keep them together. Any one of them alone answers almost nothing.

Our own retention data puts medical bills and EOBs at one to three years, with three years as the default, and seven years when the expense was paid from an HSA or FSA or claimed as a deduction (Granite document retention data, August 2026). The retention timeline tool will compute the shred date for you, and our guide to how long to keep documents covers where medical records sit against everything else.

Where Granite files each one, honestly

Worth saying plainly, because it is a real limitation. Granite has no superbill schema yet.An EOB is a recognized document type, and our collection rules key it to the carrier, so EOBs group under your insurance company. A superbill lands as a generic medical document, and those key to the provider, so it groups under your therapist’s practice. The result is that the two halves of one reimbursement file themselves into two different places unless you link them.

For now the workaround is manual: search by the date of service, which appears on both, and keep the payment record with whichever half you touch first. A superbill schema is on our list precisely because of this split, and this guide is part of how we decided it belonged there.

The wider version of this problem is not specific to us. Superbills are one stack inside a much larger pile, and our guide to organizing medical records at home covers sorting the whole thing by person.

If you’re the provider

Your patient is going to hand your document to a claims processor who has never met you, and the processor’s only question is whether every required field is present. Two insurers publish that list, so it costs nothing to satisfy both.

Put your NPI and your tax ID on every superbill as separate, labeled fields. Sign and date it. Give each date of service its own line with its own CPT code, units, and charge. We recommend showing a zero balance, because a document that looks like an unpaid invoice invites a different question. Use the correct place-of-service code for telehealth rather than defaulting to 11. And put a diagnosis code on it, because without one the claim has nothing to attach to.

One more thing that costs a minute and saves your front desk an hour: tell the patient what the document is, that they file it with their plan’s member claim form, and that there is a deadline. Most of that confusion starts with a superbill handed over in silence.

How long to keep it

Keep a superbill for three years by default, and seven years if the expense was paid from an HSA or FSA or claimed as a medical deduction. Keep it with the matching EOB and the proof of payment, because the trio is what answers a question years later.

The three-year floor is about disputes and reconciliation. The seven-year version is our own retention guidance for expenses paid from an HSA or FSA or claimed as a deduction, not an IRS rule: Publication 969 tells you to keep the records with your tax records and sets no number of years. Seven is the number we publish in our own retention data, and it is a judgment call rather than a citation.

This is exactly the kind of paperwork that matters twice: once when you file the claim, and once again years later when someone asks you to prove a number. Drop a superbill into Granite and it reads the document, pulls out the provider, the dates, and the amount, and files it without you tagging anything. Ask it a plain-English question later and you get the figure with a citation to the page it came from. Everything is encrypted at rest, and you can start free.

One boundary worth stating. Granite is not a billing service and does not give tax, medical, or insurance advice. It reads and files your documents and answers questions against them. Whether to submit a claim, which diagnosis code belongs on it, and how to treat an expense at tax time are decisions for you, your provider, and your preparer. This guide is general information, and plan rules change.