What Is a Superbill and How Does Out-of-Network Reimbursement Work for Psychiatric Care?

One of the most common reasons people hesitate to pursue private-pay psychiatric care is cost. When a practice does not accept insurance, the assumption is often that the full cost comes out of pocket with no path to reimbursement. For many patients, that assumption is not accurate.

If you have a PPO insurance plan, you may be able to recover a meaningful portion of the cost of psychiatric care through a process called out-of-network reimbursement. The tool that makes this possible is a superbill.

Understanding how this works can change the calculation significantly for patients who are weighing the cost of private-pay care against the limitations of what their insurance network offers.

Empathy Therapy is a telehealth psychiatry and psychotherapy practice built around empathic therapy, where genuine connection, careful listening, and integrated care are the foundation of every patient relationship. Dr. Mark Chofla, DO, is a board-certified psychiatrist who completed his undergraduate education at the University of California, Davis, his medical training at Midwestern University College of Osteopathic Medicine in Arizona, and his psychiatry residency and internship at the University of Southern California (USC). He has also served as a Professor of Psychiatry at the University of California, Davis Medical Center and School of Medicine. Dr. Chofla provides both psychiatric medication management and formal psychotherapy for patients across a wide range of challenges including anxiety, depression, ADHD, bipolar disorder, trauma, grief, and life transitions.

Empathy Therapy serves adults, adolescents, and children across California, Oregon, Washington, Arizona, Alaska, New York, and Florida via telehealth. New patient intakes are 75 minutes. Follow-up appointments are 45 minutes. New patients are typically seen within days, not weeks. Evening appointments are available for patients in New York and Florida. Empathy Therapy provides superbills for all appointments.

What Is a Superbill?

A superbill is a detailed receipt provided by a healthcare provider after an appointment. It contains the specific information that insurance companies require to process a claim for out-of-network services.

A standard superbill includes the provider's name, credentials, and National Provider Identifier (NPI) number, the practice name and contact information, the date of service, the diagnosis code, the procedure code describing the service provided, the fee charged, and confirmation that payment was made.

This document is not a claim form itself. It is the information a patient needs to submit a claim to their insurance company for potential reimbursement of out-of-network services. The patient submits the superbill directly to their insurance company, and if the plan includes out-of-network benefits, the insurance company reimburses the patient directly for a portion of the cost.

At Empathy Therapy, patients receive a superbill after every appointment. Dr. Chofla's office can provide guidance on the process for patients who are unfamiliar with how to submit a claim.

What Is Out-of-Network Reimbursement?

Most insurance plans fall into one of two broad categories: HMO plans and PPO plans.

HMO plans, Health Maintenance Organization plans, generally require patients to use providers within the plan's network. Out-of-network care is typically not covered at all under an HMO, with limited exceptions for emergencies.

PPO plans, Preferred Provider Organization plans, are more flexible. They allow patients to see providers outside the insurance network and still receive some level of reimbursement, though typically at a lower rate than for in-network care. The patient pays the provider directly and then submits a claim to the insurance company for partial reimbursement.

For patients with PPO plans, this means that seeing an out-of-network provider like Dr. Chofla at Empathy Therapy does not necessarily mean paying the full cost with no recovery. Depending on the specific plan, patients may recover anywhere from 20 to 60 percent or more of the allowed amount after meeting their out-of-network deductible.

How to Find Out If Your Plan Has Out-of-Network Benefits

The first step is to call the member services number on the back of your insurance card and ask specifically about out-of-network mental health benefits. The questions worth asking are whether the plan includes out-of-network benefits for outpatient psychiatric care, what the out-of-network deductible is and whether it has been met, what percentage of the allowed amount the plan reimburses for out-of-network psychiatric services, what the allowed amount is for psychiatric evaluation and follow-up visits, and what the process is for submitting an out-of-network claim.

Getting clear answers to these questions before starting care helps set realistic expectations about what reimbursement will look like.

How the Reimbursement Process Works Step by Step

The process is more straightforward than many patients expect.

After each appointment at Empathy Therapy, a superbill is provided. The patient logs in to their insurance company's member portal or calls member services and submits a claim for out-of-network reimbursement. The superbill contains all the information the insurance company needs to process the claim. The insurance company reviews the claim, applies any remaining out-of-network deductible, and issues a reimbursement check or direct deposit to the patient for the applicable portion of the allowed amount.

The timeline for reimbursement varies by insurance company, but is typically two to six weeks after submission.

Some patients find it helpful to submit claims after every appointment. Others wait and submit several at once. Either approach works. Dr. Chofla's office can answer questions about what information is needed and how to complete the submission process.

Why Private Pay Psychiatric Care Is Still Worth Considering

For patients who are accustomed to paying insurance copays and nothing more, the upfront cost of private-pay psychiatric care can feel significant. Understanding out-of-network reimbursement changes that picture for many patients, but it is also worth understanding what the private-pay model makes possible that insurance-based care typically does not.

Insurance-based psychiatric care is structured around reimbursement rates that drive appointment length down. The standard medication management appointment in an insurance-based practice runs 15 to 20 minutes. That is not a choice providers make because it is clinically optimal. It is what the economics of insurance-based practice require.

At Empathy Therapy, new patient intakes are 75 minutes, and follow-up appointments are 45 minutes. Those appointment lengths exist because the practice operates outside insurance constraints entirely. Dr. Chofla is not managing a volume of patients that insurance economics require. He is managing a practice built around quality of care.

For patients who have experienced 15-minute medication checks, rotating providers, and months-long waitlists in insurance-based settings, the difference in what private-pay care actually delivers is often more significant than the cost difference once out-of-network reimbursement is factored in.

One patient described that difference directly on Vitals:

"He seems expensive and you get what you pay for here. It all worked for me. Keep doing what you are doing, Dr."

Another noted on Healthgrades:

"I will say that his services are on the pricier side, but in my estimation, they are worth it for the level of care and attention he provides. I would highly recommend Dr. Chofla to anyone seeking a compassionate and knowledgeable psychiatrist."

What About HSA and FSA Accounts?

Patients with Health Savings Accounts or Flexible Spending Accounts can typically use those funds to pay for psychiatric care, including care from out-of-network providers. Because HSA and FSA funds are pre-tax dollars, using them to pay for appointments at Empathy Therapy effectively reduces the after-tax cost of care.

Patients should confirm with their HSA or FSA administrator that psychiatric care qualifies as an eligible expense under their specific plan, which it typically does, and retain their superbills as documentation for any HSA or FSA submissions.

The Cost Comparison Worth Making

When evaluating the cost of private-pay psychiatric care, the comparison worth making is not between the full session fee and a copay. It is between the total value of the care received, including appointment length, provider consistency, access, and integrated treatment options, and the total cost after any out-of-network reimbursement and HSA or FSA offsets.

Many patients who have done this calculation find that the gap between private-pay care and insurance-based care is smaller than they assumed, and that what they are getting for the difference is substantially better.

As one patient shared on Vitals:

"Dr. Chofla and his entire office epitomize excellence. Other single doctor practices never get back to you. It is infuriating. Call Dr. Chofla and they get back to you. Ask them a question and they explain."

Getting Started

New patient appointments are available now across all seven states. The process begins with a 75-minute intake appointment conducted via secure telehealth. No referral is required. Superbills are provided after every appointment for patients who wish to pursue out-of-network reimbursement.

To schedule or learn more, visit www.empathytherapy.com.

The information in this article is intended for educational purposes only and does not constitute medical or financial advice. Patients are encouraged to contact their insurance provider directly for information specific to their plan and benefits.

Frequently Asked Questions

What is a superbill? A superbill is a detailed receipt provided after a healthcare appointment that contains the information insurance companies require to process an out-of-network reimbursement claim. It includes the provider's credentials, diagnosis code, procedure code, date of service, and fee charged.

Does Empathy Therapy provide superbills? Yes. Empathy Therapy provides superbills after every appointment for patients who wish to submit claims to their insurance company for out-of-network reimbursement.

Can I get reimbursed by my insurance for out-of-network psychiatric care? Patients with PPO plans that include out-of-network benefits may be eligible for partial reimbursement. The amount varies by plan. Patients should contact their insurance company directly to ask about out-of-network mental health benefits before starting care.

What is the difference between an HMO and a PPO for out-of-network care? HMO plans generally do not cover out-of-network care except in emergencies. PPO plans typically include out-of-network benefits that allow patients to see providers outside the network and receive partial reimbursement.

Can I use my HSA or FSA to pay for appointments at Empathy Therapy? Yes. Psychiatric care is typically an eligible expense under HSA and FSA plans. Patients should confirm with their HSA or FSA administrator and retain superbills as documentation.

How do I submit an out-of-network claim? After receiving your superbill from Empathy Therapy, log into your insurance company's member portal or call member services to submit the claim. The superbill contains all the information needed. Reimbursement typically takes two to six weeks.

What conditions does Dr. Chofla treat? Dr. Chofla works with adults, adolescents, and children experiencing anxiety, depression, ADHD, bipolar disorder, trauma, grief, life transitions, burnout, and a wide range of other mental health challenges.

How long are appointments? New patient intakes are 75 minutes. Follow-up appointments are 45 minutes.

How soon can I be seen? New patients are typically seen within days, not weeks.

Are evening appointments available? Evening appointments are available for patients in New York and Florida.

Which states does Empathy Therapy serve? Empathy Therapy serves adults, adolescents, and children across California, Oregon, Washington, Arizona, Alaska, New York, and Florida via telehealth.

How do I get started? Visit www.empathytherapy.com to schedule a new patient intake. No referral is required. New patients are typically seen within days.