Superbills for Therapy: Claiming Back Out-of-Network Costs

Many practitioners who understand trichotillomania (trich) don’t take insurance. That can put therapy out of reach, even when you pay for a health plan every month. But many US plans still pay back part of the cost when you see someone outside their network, and the tool that makes this work is a superbill.

This guide explains what a superbill for therapy is, what it must include, and how to claim with it. It’s for adults paying for their own therapy and for parents paying for a child’s.

What is a superbill?

A superbill is an itemized receipt from your practitioner that lists everything your health insurer needs to process a claim: who you saw, when, what kind of session it was, why, and what it cost. You pay your practitioner in full, then send the superbill to your insurer with a claim form. If your plan covers out-of-network care, the insurer pays some of the cost back to you.

An ordinary receipt usually isn’t enough, because it doesn’t have the codes. A diagnosis code says what the care is for. A procedure code, known as a CPT code, says what kind of session took place. The superbill puts both on one page, with your practitioner’s details. Practitioners usually make them from their billing software, after each session or once a month.

Does insurance cover therapy for trichotillomania?

Often, yes, but it depends on the plan. Trichotillomania is a recognized mental health condition with its own diagnosis code, so therapy for it can be covered like other mental health care. A federal law on mental health parity says most group health plans that cover out-of-network care for medical problems have to offer out-of-network mental health benefits on similar terms.

What matters most for superbills is your plan type. Your plan documents, or the number on your insurance card, will tell you which you have.

Insurers also decide which kinds of practitioner they pay for. Before you rely on a superbill, ask your insurer whether it covers your practitioner’s license type.

How do out-of-network benefits work?

Out-of-network benefits pay part of the cost when you see a practitioner who has no contract with your plan. You pay the fee up front, and your plan pays you back a share of what it thinks the session should cost. Four terms decide how much you get back:

• Allowed amount: the most your plan will pay for a service. Out of network, this is often lower than your practitioner’s fee.
• Deductible: what you pay each year before your plan starts to pay. Some plans have a separate deductible for out-of-network care.
• Coinsurance: the percentage of the allowed amount you pay once you’ve met your deductible. It’s often higher out of network.
• Balance billing: when a practitioner charges the difference between their fee and the allowed amount. With a superbill, you’ve already paid that difference yourself.

If your plan is from New York

New York has its own rule for many state-regulated plans with out-of-network cover. It sets a benchmark called the usual and customary cost: the 80th percentile of what practitioners of the same type charge for that service in your area. Insurers must offer at least one plan option that pays 80% of that benchmark after the deductible. The rule doesn’t apply to self-funded employer plans, Medicare or plans issued outside New York, so ask which kind you have. You can search for practitioners in New York who understand hair pulling.

What should the superbill include?

A superbill should include your details, your practitioner’s details, and the codes, dates and fees for each session. If anything is missing, the claim is likely to come back unpaid.

The CPT codes you’re most likely to see are:

For online sessions, the place of service code is usually 10 if you’re at home and 02 if you’re somewhere else. Our guide to online therapy for trichotillomania covers how online sessions work.

How do I claim back costs?

Check your benefits, pay for the session, get the superbill, then send it to your insurer with their claim form. You can often send a claim online or through your insurer’s app.

1. Call your insurer before your first session, using the questions below.
2. Pay your practitioner and keep your own record of dates and amounts.
3. Ask for a superbill, and check it against the table above.
4. Send it with the insurer’s claim form, from your member portal or app. Keep copies.
5. Read the explanation of benefits (EOB) your insurer sends back. It shows what they allowed, what they paid and why.
6. Fix and resend anything they rejected. A missing code or detail is a common reason, and your practitioner can issue a corrected superbill.

Questions to ask your insurer:

• Do I have out-of-network benefits for outpatient mental health care?
• What’s my out-of-network deductible and coinsurance, and how much of the deductible have I met?
• How do you set the allowed amount for CPT codes 90791 and 90834 or 90837?
• Do I need pre-approval or a referral? Are online sessions covered?
• Which license types do you cover?
• What’s the deadline for sending in a claim?

Note the date and a reference number for the call. If your insurer turns down a claim, you usually have the right to ask it to review the decision, and in many cases to ask for an independent review.

How much money will I get back?

It depends on your plan’s allowed amount, your deductible and your coinsurance, so it varies a lot from plan to plan. Your insurer can give you a closer figure if you tell them the CPT code and the fee.

Private sessions in the US often cost $100 to $250, with many around $150 to $175. Here’s a made-up example to show how the sums work.

Before your deductible is met, you may get nothing back. Keep sending superbills anyway: they count toward your deductible, and once it’s met, refunds start. Our guide to what therapy for trichotillomania costs has more on typical fees.

Using an HSA or FSA

A health savings account (HSA) or flexible spending account (FSA) lets you pay for medical care with money set aside before tax. IRS rules count payments to psychologists and for psychiatric care as medical care, so therapy for a mental health condition generally qualifies. You can use the account for the part your plan doesn’t pay back, but not for dollars your insurer refunds.

If you’re paying without insurance

If you don’t have insurance or aren’t using it, federal rules under the No Surprises Act say practitioners must give you a Good Faith Estimate: a written estimate of what your care should cost. If your bill comes in $400 or more above it, you can challenge the bill through a federal dispute process. Even if you plan to use a superbill, it’s reasonable to ask for a written estimate.

Where can I find someone who understands trich?

Start with someone who understands hair pulling, then check how they handle payment. Practitioners who don’t take insurance can often give you a superbill. Ask on your first call whether they provide one and which codes they usually use, so you can check with your insurer first.

Everyone in our directory has told us they understand trichotillomania and already help people who pull, in person or online. You can search the directory or browse by state. Our guide to finding someone who understands trich explains what to look for.

If you’re a parent paying for your child’s therapy, The Parent’s Guide to Trichotillomania can help alongside it: understanding what your child is going through.

Questions people ask

Sources

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2. HealthCare.gov. Glossary: Coinsurance.
3. HealthCare.gov. Glossary: Deductible.
4. HealthCare.gov. Glossary: Non-preferred provider.
5. HealthCare.gov. Glossary: Health Maintenance Organization (HMO).
6. HealthCare.gov. Glossary: Preferred Provider Organization (PPO).
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8. US Department of Labor, Employee Benefits Security Administration. Mental health and substance use disorder parity.
9. Centers for Medicare & Medicaid Services (2025). Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services (A57520).
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11. Centers for Medicare & Medicaid Services. Place of Service Code Set.
12. Centers for Medicare & Medicaid Services. National Provider Identifier Standard (NPI).
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17. Internal Revenue Service (2025). Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans.
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21. Cigna (2023). Medical Claim Form 591692c, rev. 11/2023.
22. Psychiatric News (2013). ICD codes for some DSM-5 diagnoses updated.