A superbill is the document an out-of-network provider gives you so that you can ask your own health plan to repay you. Therapists, dietitians, physical therapists, and specialists who do not contract with insurers often hand patients a superbill instead of billing the plan directly. The provider is paid by you at the visit, and you file the paperwork afterward. Whether any money comes back in 2026 depends entirely on whether your plan has out-of-network benefits, which is a plan design question, not a paperwork question.
The guide below explains what a superbill contains, how a 2026 reimbursement is calculated, how to submit one, and what to do when a plan pays nothing. For the underlying terms, see the glossary entry on in-network vs out-of-network and the page on balance billing. No 2027 reimbursement figures exist yet; plan deductibles and coinsurance for 2027 are set by each insurer and appear in your plan documents.
Coverage Breakdown
Direct answer: what a superbill is and who pays
It depends on your plan. A superbill is an itemized receipt, not a claim, so it guarantees nothing. PPO and POS plans often repay part of the allowed amount after the deductible. HMO and EPO plans usually pay nothing out of network except for emergencies.
What a superbill must list
Insurers process a superbill much like the standard claim form a contracted provider would send, so the details must be complete or the claim is returned. A superbill that only says "therapy session, paid" is a receipt, and most plans will reject it. Ask your provider to confirm each item below before you leave, because corrections later can take weeks and your filing clock keeps running.
- Provider name, address, phone, National Provider Identifier (NPI), and tax ID number
- Your full name, date of birth, and the member ID and group number on your insurance card
- Date of service and place of service (office, telehealth, facility)
- CPT or HCPCS procedure code for each service (for example, the code for a 45 minute psychotherapy session)
- ICD-10 diagnosis code that supports the service
- Fee charged, amount you paid, and the provider's signature or credentials
How a 2026 out-of-network reimbursement is calculated
Your plan does not repay what you paid. It repays a percentage of its own allowed amount for that service, which can be well below the provider's fee, and only after you meet the out-of-network deductible. In this 2026 example, a provider charges $200 for a session and your plan's allowed amount is $150. If you have already met the out-of-network deductible and the plan pays 60% of the allowed amount, the 2026 reimbursement is $90, and you absorb the other $110.
If you have not met the deductible, the plan applies the 2026 payment to the deductible and reimburses nothing yet. In a 2026 example with a $1,000 out-of-network deductible, the first several sessions count toward that deductible, and reimbursement begins only afterward. The difference between the provider's fee and the allowed amount is not a refund you can appeal for; it is the balance the provider may bill you, because there is no contract limiting it. Out-of-network amounts also often do not count toward your in-network out-of-pocket maximum.
How to submit a superbill to your insurer
Before the first visit, call the member services number on your card and ask four questions: whether the plan has out-of-network benefits for your type of provider, what the out-of-network deductible and coinsurance are in 2026, whether it uses a reasonable and customary or allowed-amount limit, and what the claim filing deadline is. Write down the date, the representative's name, and a reference number. These answers set your expected reimbursement, and the call record helps if a claim is later disputed.
After each visit, follow the steps in the final section of this page: get a complete superbill, upload it through your insurer's member portal or mail it with the plan's out-of-network claim form, and keep proof of payment. Submit within the filing deadline in your plan documents; plans set their own limits, so a late superbill can be denied even when the care was covered. Track the claim until you receive an Explanation of Benefits (EOB).
Superbills for therapy and mental health care
Therapy is the most common reason adults under 65 search for a superbill, because many therapists do not accept insurance. Mental health and substance use services are among the ACA essential health benefits that ACA-compliant individual and small-group plans must cover (and those plans cannot deny you for a preexisting condition), but that rule does not force a plan to pay a provider outside its network. Your plan must still apply the same kind of limits to therapy that it applies to medical care, under the federal mental health parity law, and the U.S. Department of Labor handles parity complaints for employer plans.
Because therapy is recurring, set up a routine: ask the therapist for a monthly superbill, submit all sessions together if your plan allows it, and note when the out-of-network deductible is met. A diagnosis code is required on the superbill for the plan to process a claim, and a therapist may be unwilling to assign one if you want to avoid a diagnosis on your record. Discuss that before you start, because without it the plan will generally not pay.
Using a superbill with an HSA, FSA, and your taxes
A superbill or itemized receipt also works as proof for a health savings account (HSA) or flexible spending account (FSA), which pay for eligible medical expenses whether or not the provider is in network. Keep the document, because the account administrator or the IRS can ask for it. Do not take money from your insurer and from the account for the same cost: under IRS Publication 502 (the 2025 tax year edition), expenses repaid by insurance, an FSA, or a tax-free HSA distribution cannot also be counted as deductible medical expenses.
If you itemize deductions, only the unreimbursed amount counts, and only the part above 7.5% of adjusted gross income (the threshold in the 2025 tax year edition of IRS Publication 502). Reimbursement from your plan therefore lowers the amount you can deduct, so reduce your total by every repayment you receive.
What changes with Original Medicare and Medicare Advantage
Original Medicare does not use superbills the way a commercial PPO does. Providers who accept Medicare Part B file the claim themselves, and Medicare Part A covers hospital care. A provider who has formally opted out of Medicare signs a private contract with you, and then neither you nor the provider can get Medicare payment for that service. Medicare Part D drug plans have their own claim process, and Medigap supplement plans follow what Original Medicare approves.
Medicare Advantage plans work like commercial plans: an HMO version usually does not pay out of network, while a PPO version may pay part. If you are within a few months of turning 65, ask your therapist or specialist whether they accept Medicare before you switch coverage, since a superbill habit built on a commercial PPO may not carry over. Review Medicare costs on Medicare.gov and the Medigap guide at Medicare.gov before you choose.
Alternatives if your plan does not reimburse out-of-network care
A denial or a plan with no out-of-network benefit does not end your options. Five routes are worth trying before you pay full price every visit, and each has a place to start. Compare the 2026 cost of each against the full fee, and use the medical bill analyzer if a bill or explanation of benefits looks wrong.
How to file a superbill claim, step by step (2026)
Filing a superbill follows the same five steps whether you see a therapist, a physical therapist, or a specialist. Start at your insurer's website or the member services number on your card; your plan's claim form is usually under a Forms or Claims menu. If the plan denies the claim, the denial letter must explain why, and you have the appeal rights described in the alternatives table above.
Frequently Asked Questions
What is a superbill?
A superbill is an itemized receipt from a provider that lists your diagnosis codes, procedure codes, fees, and the provider's identifiers. You send it to your health plan to ask for out-of-network reimbursement. It is not a claim form that guarantees payment, and your plan decides what, if anything, it repays in 2026.
How do I submit a superbill to insurance?
Get a complete superbill from your provider, then upload it through your insurer's member portal or mail it with the plan's out-of-network claim form. Include proof of payment and keep copies. Submit within the filing deadline in your plan documents, then watch for an Explanation of Benefits showing what was paid or denied.
Will my insurance reimburse a superbill for therapy?
Only if your plan has out-of-network mental health benefits. PPO and POS plans often do, after an out-of-network deductible, and pay a percentage of the plan's allowed amount. HMO and EPO plans usually pay nothing for planned out-of-network therapy. Call member services before your first session to confirm the 2026 deductible and coinsurance.
How much will I get back from an out-of-network superbill?
It is a share of the plan's allowed amount, not of what you paid, and only after the out-of-network deductible. In a 2026 example, a $200 session with a $150 allowed amount and 60% coinsurance returns $90 once the deductible is met. Your own plan documents set the real percentages.
Can I use an HSA or FSA with a superbill?
Yes. Eligible medical expenses can be paid or reimbursed from an HSA or FSA whether or not the provider is in network, and a superbill or itemized receipt serves as proof. You cannot be repaid twice for the same cost, and IRS Publication 502 excludes insurer-reimbursed expenses from the medical expense deduction.
Does the No Surprises Act cover out-of-network care I choose myself?
Generally no. The No Surprises Act, effective January 1, 2022, protects you from unexpected out-of-network bills for emergency care, some non-emergency care at in-network facilities, and air ambulance services. Choosing an out-of-network therapist or specialist on your own is not covered, so ask about the fee in writing first.
What if my insurer denies my superbill claim?
Read the denial letter for the reason, fix any missing information, and resubmit if it was a paperwork error. Otherwise, file an internal appeal. On HealthCare.gov, you generally have 180 days from the denial notice, and the insurer must decide within 30 days for care not yet received or 60 days for care already received.
Does Original Medicare accept superbills?
Generally no. Providers who accept Medicare Part B submit the claim themselves, and a provider who has opted out of Medicare signs a private contract with you, after which Medicare pays nothing for that service. Medicare Advantage plans follow their own rules, and an HMO version usually does not pay out of network.
