Free tool
How many hours your billing paperwork really takes
Count the monthly minutes spent on superbills, corrections and benefits calls, then see the same total as lost client hours and full workdays a year.
Free tool, no sign up
What your client gets back on a superbill
Enter your fee, the plan allowed amount and the remaining out of network deductible to see the likely monthly reimbursement and the real cost to your client.
Clients ask what they will get back, and the honest answer starts with a number most of them have never heard of. Plans reimburse a share of an allowed amount for the CPT code, not a share of your fee. If your rate is above that allowed amount, the difference is the client cost to carry and no percentage quoted on the phone changes it.
This calculator does the arithmetic that decides whether a client stays in weekly therapy. Run it during the consultation with real numbers from the client plan documents or a benefits call, and run it again after the January reset when the deductible starts over and reimbursement briefly drops to nothing.
Your result
You collect this month
$700
The full fee your client pays you directly across the month.
Likely reimbursement to the client
$162
What the plan sends the client once the superbill has been processed.
Net cost to the client
$538
What therapy actually costs the client once the reimbursement arrives.
Share of your fee recovered
23.1%
Reimbursement as a percentage of what the client paid you.
These are estimates. The allowed amount decides almost everything here, and only the payer can confirm it on a processed claim.
Why the allowed amount decides everything
Therapists often answer the reimbursement question with the coinsurance share, because that is the number a benefits rep says most clearly. It is the wrong anchor. If your fee is 175 and the plan allowed amount for the code is 130, the arithmetic begins at 130 and the remaining 45 belongs to the client no matter what the plan pays.
Explaining that once, early, is the single most valuable thing you can do for retention. A client who understands allowed amounts is not shocked by the first explanation of benefits, and a client who is not shocked does not quietly stop scheduling in the second month.
Using this before the first session
Run it during the consultation call with the client own deductible figure, taken from their plan documents or from a verification of benefits call. Say the monthly cost and the likely reimbursement out loud, and say plainly that the allowed amount is an estimate until a real claim comes back processed.
Then run it again in January. Deductibles reset, clients forget, and reimbursement falls to zero until the new deductible is met. That conversation, held in advance, prevents most of the winter attrition that hits out of network practices every single year.
Questions about this calculator
Where do I find the plan allowed amount for a code?
A verification of benefits call is the usual route, and reps will sometimes quote an allowed amount for a specific CPT code. The more reliable source is a past explanation of benefits from another client on the same plan and the same code. Treat any figure as an estimate until a claim has actually been processed.
Does this handle the deductible resetting each year?
Enter whatever remains on the out of network deductible at the moment you run it. If the plan year has just reset, enter the full amount and you will watch reimbursement fall to zero for the first months. That is the honest picture and it is worth showing clients before they discover it themselves.
Why does the money go to the client rather than to me?
On an out of network superbill the client has already paid your full fee, so the plan reimburses the client directly. That is the entire logic of the document. It is also why your practice cash flow does not depend on payer processing times.
More free tools and working documents
Working document
The out of network superbill readiness checklist
Four stages of checks that keep every monthly superbill complete, accurate and ready for a client to submit without coming back to you for a correction.
Turn that figure into a document a plan can read
The number this calculator just gave you stays hypothetical until a complete superbill reaches the client and an explanation of benefits comes back with a real allowed amount on it. In a demo we set the CPT code, diagnosis, fee and place of service for a few of your clients and build one month of documents so you can see the same arithmetic on paper. Nothing is filed with any payer on your behalf, because the client still submits.