Insurance & Fees

Don’t let the name scare you – it’s not a SUPERbill. A superbill is essentially an invoice that details all of the information needed to be submitted to insurance. We make it easy by having all of the required information automatically populate for you to submit to your insurance. Depending on your insurance, we can submit claims on your behalf per session or per month.

Your superbill includes the following information:

• Your name, home address, and contact information
• Your insurance information, including your insurance company, member ID, plan number, and group number.
• New Leaf Marriage & Family Therapy’s name, address, and contact information.
• New Leaf Marriage & Family Therapy’s billing information, such as our tax ID and NPI number.
• The dates of service for the month provided
• With this, it includes the necessary information such as: your diagnosis code, the type of therapy received (individual or family/couples), office location, total due per service, and the amount paid by you.
• Directions to make out reimbursement payments directly to you.

You would pay our full session fee per session directly to our group. We will record these payments on the superbill. These superbills are submitted as an out-of-network claim to your insurance, where your payments get applied to your out of network deductible. Please note, the insurance may only apply an “allowed amount”, which can be only a portion of what you actually paid, to your deductible. For example, they can apply 50% of your out of pocket payment to 100% towards meeting your deductible; all depending upon your plan. They may also be able to share what this allowed amount may be, but some insurances need to receive a claim and calculate it at that time to understand what the allowed amount is.

When your deductible has been reached, you would still pay our group the full session fee, and the superbills would continue to submit to your insurance as a claim. However at this point, the insurance will begin reimbursing you a percentage back for paying out of pocket. This could look like reimbursing you 40-90% of your total payment after it has been processed.

Superbills can be submitted as claims once your therapist has determined your diagnosis code. What is a diagnosis code? It is a combination of letters and numbers that represents a medical condition. For example, a diagnosis code for Generalized Anxiety Disorder is F41.1. This information is crucial for your superbill to be processed properly through your insurance.

You can expect that your therapist aims to have a solid diagnosis code for you within the few four weeks of treatment. This is due to the allocated time for you and your therapist to effectively review your symptoms, document frequency of symptoms, and establish a treatment plan for them.

With a PPO plan, you have 1) an out of network deductible and 2) a reimbursement percentage. The out of network deductible is individual based upon your unique plan. The reimbursement percentage is what percent of your payments the insurance will pay you through the form of a check, which typically range from 50% to 80% of the paid amount. As an example, if you pay $175 out of pocket, you can expect to be reimbursed for $131. Your insurance can share these 2 numbers with you, and may give the disclaimer that they are estimates, and not guarantees, of your benefits.

You can call either the Customer Service or Mental Health / Behavioral Health number on the back of your insurance card and inquire about using out-of-network benefits for outpatient mental health in an office setting (CPT codes 90791 for intake session, 90834 for individual therapy & 90846 and 90847 for family/couples therapy).

If you are motivated to work with one of our amazing clinicians, we are happy to verify these benefits on your behalf! Please note that we may need to acquire additional information from you, and you may have to give verbal authorization for us to contact your insurance. Also, some insurances prohibit anyone other than the plan members to collect this information as well.

Your insurance may give the disclaimer that they are estimates, and not guarantees, of your benefits. This is dependent upon your individual plan, the session cost, location, and type of service. When claims get submitted, the insurance should process them according to what your stated benefits are.

Claims generally take 2 weeks to 4 weeks to get approved and fully processed. We provide superbills automatically at the start of each month for your previous month of sessions. We can also manually generate these per session upon request.

There are some cases where you can receive in-network benefits for working with an out-of-network provider. This often requires historic documentation from our group to support that we are the right clinician for your presenting needs, demonstrating the need for working with an out-of-network provider. These cases are unique, and established rapport and progress must be demonstrated for consideration. We cannot guarantee on our end that your case will be approved. Please note, the single case agreement must be between you and your insurance group, and not New Leaf and your insurance group.

An HMO plan does not provide out-of-network benefits or accept superbills. You may be able to apply for a Single Case Agreement through them (please refer to the Single Case Agreement section above).