Insurance Reimbursement

Superbills

Submit the Superbill to Your Insurance Company:
- Check if your insurance plan reimburses out-of-network providers. Submit the superbill along with any other necessary paperwork (e.g., claim form) directly to your insurance company.
Check Your Benefits:
- Make sure you’re aware of your out-of-network benefits and whether occupational therapy is covered.
- Some insurance plans may require pre-authorization or a referral for therapy services, so ensure this is in place before submitting.

Does my insurance plan cover occupational therapy?
- If yes, confirm if it’s for both in-network and out-of-network providers.
What is my coverage for out-of-network occupational therapy?
- Ask about the reimbursement rates for out-of-network services.
- How do I submit a superbill for out-of-network reimbursement?
Are there any pre-authorization requirements?
- Inquire if a referral or pre-authorization from a primary care physician or specialist is necessary before starting therapy.
What is the reimbursement process for a superbill?
- Find out if you need to submit your superbill via an online portal, mail, or fax.
- Ask how long it typically takes for a reimbursement claim to be processed.
What codes are required for reimbursement?
- Verify which CPT and ICD-10 codes your insurer needs for occupational therapy claims.
Is there a cap on the number of sessions covered per year?
- Confirm whether there are annual limits for therapy sessions or a maximum amount that can be reimbursed.
Is there a deductible or co-payment for occupational therapy?
- Clarify whether you must meet a deductible or pay co-pays for therapy sessions.
What happens if the occupational therapist is out-of-network?
- Inquire if the reimbursement will be a lower rate and if you will be required to pay the difference.
Is there an appeal process if a claim is denied?
- Ask about the process to appeal a denied claim if reimbursement isn’t granted or is lower than expected.

You must meet your deductible before insurance covers therapy. Submit all bills from providers to help reach it.
If you have an office visit co-pay, it will be subtracted from the insurance payment, affecting reimbursement.
Reimbursement is based on your insurance’s "usual and customary rate" for services, which may differ from billed charges.
If your policy needs a prescription from your PCP, obtain one to submit with your claim. If a specialist’s prescription is required, include that as well. Submit updated prescriptions with each claim.
For policies requiring pre-authorization or a referral, contact your PCP’s office to submit one dated for your first therapy visit. Keep in mind referrals and pre-auths expire.