Get reimbursed for out-of-network therapy with superbills

  1. Identify your plan type
    15 min

    This step produces the one-line classification that governs everything that follows: whether your plan is self-funded under ERISA and federal law, or fully insured under state insurance law — and the regulator that hears your appeal. The trap: neither the coverage card nor the marketing summary states it. The answer lives only in the plan documents, and getting it wrong means your complaint lands with an agency that has no authority over your plan.

    1. Open the Summary Plan Description (SPD) and scan the cover page and first pages for the words “self-funded”, “ERISA”, or “Employee Retirement Income Security Act”.
    2. Look for the line that says who pays claims: the employer or a plan trust (self-funded), or an insurance company (fully insured).
    3. Bought the plan yourself on the Marketplace or directly from an insurer? It is fully insured — your state insurance department applies.
    4. If the document is silent, call the number on the coverage card and ask: “Is this plan self-insured or fully insured?”
    5. Record one line: “Self-funded ERISA — regulator: US Department of Labor” or “Fully insured — regulator: [state] insurance department”.

    Check yourself — this is the one classification error that can sink the whole playbook.