May 7, 2024

Understanding the Superbill: A Key Tool for Accessing Ketamine Therapy and Navigating Insurance Coverage

In the realm of mental health treatment, ketamine therapy has emerged as a ground-breaking option for individuals grappling with challenging conditions and their associated symptoms. Despite its growing reputation, the majority of insurance companies in the United States do not officially cover ketamine therapy, posing a significant barrier to its accessibility.

The United States currently faces a profound mental health crisis, with one in five adult Americans experiencing mental illness as of 2020. This means that tens of millions of individuals live with anxiety, depression, and other potentially debilitating conditions. To address this issue effectively, it is crucial to enable healthcare coverage for emerging mental health treatments like ketamine therapy, including through programs such as Medicare and Medicaid, thereby expanding access to these transformative treatments for millions of Americans.

Determining Ketamine Therapy for Depression - Coverage with Your Insurance Provider

While coverage for ketamine treatment for depression and anxiety may be limited, there are steps you can take to determine if your insurance provider offers any assistance or coverage for the cost of ketamine treatment.

1. Contact your insurance provider first: Before embarking on ketamine therapy, it is advisable to reach out to your insurance provider to inquire about any potential coverage or subsidies they may offer for the treatment. While coverage varies on a case-by-case basis, some insurance providers are willing to cover certain upfront costs associated with ketamine treatments for depression and anxiety. Discussing these possibilities with an insurance representative ahead of time can provide valuable insights.

After receiving care, your insurance provider may send an "explanation of benefits" outlining the treatment costs and the extent of insurance coverage. In some cases, you may need to meet your deductible before receiving full or partial coverage for the services rendered.

2. Inquire about out-of-network reimbursement: Some insurance providers may require you to initially pay for the treatment out-of-pocket and subsequently reimburse you. This process, known as "out-of-network" reimbursement, allows you to seek coverage for healthcare services received from providers outside your insurance network. Each insurance provider has its own unique procedures for processing and reimbursing out-of-network claims. Depending on your coverage, you may receive full or partial reimbursement in the following weeks. It is crucial to clarify the out-of-network coverage requirements or reimbursement policies with your insurance provider before pursuing treatment.

3. Provide a superbill, if requested. A superbill may allow you to receive reimbursement for your ketamine therapy treatments. Let's look more in-depth at what a superbill is and how it can be used in the realm of ketamine therapy.

What is A Superbill? 

A superbill is an itemized form used by healthcare providers detailing the services a patient received. It is provided to the patient to submit to their insurance company for reimbursement. However, it's crucial to know that not everything related to your ketamine therapy might be covered in a superbill.

What Is Typically Included in a Superbill?

A superbill usually includes:

  1. The provider's contact information
  2. The patient's information
  3. Date of service
  4. Diagnosis codes
  5. Procedure codes for services rendered
  6. The cost of each service

The diagnosis and procedure codes come from standard medical coding systems, which are used universally to identify specific health conditions and treatments.

What May Not Be Included?

While the superbill covers the cost of services directly related to the patient's treatment, it might not include other aspects. These may involve:

  1. Administrative Costs: These refer to behind-the-scenes operations such as staff salaries, technology/platform costs, utility bills, and other overhead expenses. They are typically not included in the superbill.
  2. Indirect Patient Services: Certain services that are indirectly related to patient care, like educational programs, may not be included in the superbill.
  3. Complementary Therapies: If your ketamine therapy program involves complementary therapies like yoga, meditation, or acupuncture, they might not be included in the superbill. This exclusion depends on your insurance company's coverage policies and the specific billing practices of the healthcare provider.
  4. Miscellaneous Supplies and Services: Things like the brain box, better u meditation mask, personal comfort items, or non-prescription medications are typically not included in a superbill.

Options if You Can't Find Coverage

Utilizing HSA/FSA Accounts

Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) represent tax-advantaged financial resources that enable individuals to allocate funds for health-related expenditures, as specified by the Internal Revenue Service (IRS). Often, these accounts come with a debit card to facilitate payments for services in-person or digitally.

Certain treatment services offered by Better U could potentially be recognized as qualified expenses, hence it might be possible to use HSAs or FSAs for your treatment payments. To confirm if these services are indeed eligible, you could attempt to use these account cards at the payment stage. If payment with these cards is unsuccessful, it would be advisable to consult with the card's provider to understand the eligible expenses, as the final decision rests with them. It's important to note that Better U cannot influence their determination. It is also important to understand that the Superbill only states what may be reimbursable by insurance (not other expenses in the packages that are related to your care).

Exploring Monthly Payment Plans and Alternative Financing Options

Here at Better U, we allow you the flexibility to explore payment plans or other financial arrangements that allow the cost of treatment to be spread over an extended period. This can help ensure you receive immediate treatment while mitigating the impact of the cost by distributing it over a longer duration. We work alongside Klarna, Splitpay, Affirm, and others to help you along your journey.

Insurance Coverage for Ketamine Therapy at Better U 

It's crucial to have a clear understanding of your health insurance plan and what it covers. Contact your insurance company to inquire about coverage for ketamine therapy, and don't hesitate to ask your healthcare provider for clarity on what to expect on your superbill.

Remember, your healthcare provider's team is there to support you. They can help answer your questions and navigate these complex topics, allowing you to focus on what's most important: your healing journey.

This blog is meant to be informative and does not replace professional financial or medical advice. Always consult with insurance professionals or healthcare providers for personalized advice.