How to Use a Super Bill for Potential Reimbursement in Therapy

Starting Therapy

By Elizabeth Mahaney, LMHC, MFT, CCTP, NCC, Ph.D.

Learn all about leveraging a super bill to maximize insurance reimbursement for your counseling sessions at South Tampa Therapy.

Counseling is a vital investment in your mental health, well-being, and interpersonal connections. If you're curious about utilizing insurance coverage for therapy, continue reading to discover our FAQs or reach out to us at 813-240-3237.

How to Utilize Insurance with South Tampa Therapy:

At South Tampa Therapy, we only accept United, Aetna, and Cigna. We also presently do not accept insurance directly from any other insurance company. Instead, clients pay for online or in person therapy sessions upfront, with charges processed via their card on file. As an out-of-network provider, reimbursement isn't guaranteed unless explicitly outlined in your policy. However, we provide a super bill for potential partial reimbursement. Before commencing services, we advise contacting your insurance to inquire about out-of-network coverage. Should you prefer an in-network provider, we're happy to assist with referrals.

Key Questions to Ask Your Insurance Before Starting with South Tampa Therapy:

Contact your insurance's member services and inquire about out-of-network coverage for telehealth mental health services. Clarify:

• Deductible status and amount remaining.

• Coverage limit for sessions annually.

• Reimbursement rates for CPT codes 90834 and 90837.

• Coverage for Z codes pertaining to couples therapy.

• Co-payment details (if applicable).

• Requirements for prior authorization or primary care provider approval.

• Super bill submission process, including deadlines.

• Correct address for reimbursement checks.

Understanding the Super Bill:

A super bill serves as a detailed record of therapy services received, facilitating potential reimbursement. It must include:

• Client and therapist details.

• Statement number and issuance date.

• Diagnosis and corresponding code.

• Service specifics and fees paid.

Points to Consider Before Submitting a Super Bill:

• Reimbursement necessitates a clinical diagnosis from DSM–5 or ICD-10.

• Couples therapy may not be reimbursed by insurance due to diagnostic requirements.

• Discuss any diagnosis-related concerns with your therapist.

Submitting Your Super Bill:

Most insurers mandate submitting super bills within 90 to 180 days to meet timely filing requirements. Options include:

1. Mail: Obtain the insurer's mailing address and allow ample time for delivery.

2. Fax: Ensure privacy by avoiding public or work fax machines.

3. Online Portal: Utilize the insurer's secure portal for faster submission.

Post-Submission Expectations:

Insurers typically take 2-4 weeks to process super bills. Reimbursement may cover session costs minus co-pays or contribute towards deductibles. In case of denial, contact your insurer for clarification.

By optimizing your understanding of super bills and insurance processes, you can navigate potential reimbursement for therapy sessions effectively. For further assistance, reach out to South Tampa Therapy 813-240-3237.

Insights from The Gottman Institute: The Four Horsemen of the Apocalypse

Dr. John Gottman, a renowned psychologist and researcher, has dedicated his career observing relationships on a quest to discover what makes them work and what causes them to unravel. One of his most influential concepts is known as "The Four Horsemen of the Apocalypse," which identifies four communication patterns that can lead to the downfall of a romantic relationship if left unchecked. The four horsemen are:

Criticism

Contempt

Defensiveness

Stonewalling

Criticism

The first horseman, criticism, is attacking a partner's character rather than addressing a specific behavior or issue. It involves making sweeping negative statements about the other person, often using terms like "always" or "never." It sounds something like this:

“You always forget to do the dishes. I can never rely on you.”

Criticism can be destructive as it erodes the other person's self-esteem and creates a hostile atmosphere. Gottman's research shows that persistent criticism can be particularly harmful because it tends to escalate conflicts, making them more difficult to resolve. 

The better approach, or “antidote,” to criticism is the gentle start-up. Rather than blaming or finding fault with a partner’s behavior, it is more helpful to focus on using "I" statements, such as "I feel frustrated when the dishes aren’t done."

Contempt

Contempt is perhaps the most corrosive of the four horsemen. It involves expressing disdain, disrespect, or superiority towards one's partner. This can manifest as sarcasm, mockery, name-calling, or eye-rolling. Contempt often stems from a deep sense of resentment and can lead to long-lasting emotional wounds. It sounds like this:

“You still haven’t finished the taxes? (Eye roll.) Why am I the only competent person around here?”

Gottman's research indicates that contempt is a strong predictor of relationship dissatisfaction and divorce. 

The antidote to contempt is building a culture of respect and appreciation towards one’s partner. It’s challenging to break the cycle of contempt, but with time and better habits of expressing gratitude and appreciation, couples can begin to feel the love and respect needed to buffer against times of conflict.

Defensiveness

The third horseman, defensiveness, is a natural response to feeling attacked or criticized. Defensiveness shows up as making excuses, denying wrongdoing, or playing the victim. Unfortunately, it is also counterproductive when it involves shifting blame and failing to take responsibility for one's actions. It goes like this:

“It’s not my fault. You’re the one who overreacted.”

The antidote to defensiveness is taking ownership of one's mistakes and listening to their partner's perspective without immediately becoming defensive. A better response sounds like, "I understand why you're upset, and I'm sorry for my part in this."

Stonewalling

The fourth horseman is stonewalling which involves withdrawing from an interaction or conversation, often in response to feeling overwhelmed by conflict or criticism. Stonewalling occurs when one partner disengages, emotionally shuts down, or refuses to communicate, which leaves the other partner feeling unheard and rejected. It looks like this:

Crossing arms . . . looking away . . . staying silent . . . exiting the room.

The antidote to stonewalling is physiological self-soothing by taking a break. Couples should establish strategies for cooling off but commit to returning to the conversation later to resolve the issue constructively.

The Four Horsemen of the Apocalypse provide valuable insights into the dynamics of relationships and how negative communication patterns can lead to their downfall. By recognizing and addressing these behaviors – criticism, contempt, defensiveness, and stonewalling – couples can work towards healthier, more satisfying relationships. 

Author: Lana Phillips

Book Appointment: https://southtampacounselor.com/bookappointment

Empowering Couples to Communicate Compassionately~ Using Non-Violent Communication (NVC)

The process of non-violent communication (NVC) was developed by Marshall B. Rosenberg and encourages us to connect with others in a more heartfelt and empathetic manner. NVC emphasizes the significance of language in our day-to-day encounters, calling for conscious responses, instead of reactions, based on perceptions, feelings, needs, and visions for what we DO want to see happen.

The Four Components of NVC

There are four basic components to NVC that include observations, feelings, needs, and requests. What actions are we seeing around us that have an impact on our well-being? How do we feel based on what we've seen or heard? What need, desire, or value sparked those feelings? All negative feelings are unmet needs. Finally, how may we make positive requests of others that will improve our lives? These elements all work together to create NVC's foundation.

Our Language Shapes Our Thinking

Sometimes our thoughts sabotage our needs. It is helpful to gather more data and not just react from our triggers or automatic thoughts. Our thoughts produce the way we feel. Negative thoughts point to an unmet need. If I don't know what I need and react from the story that I tell myself, a lot of bad habits can form from this bad habit. Instead, I can gather more data, not just from thoughts but I want to drop down and gather more data from my feelings, where my feelings live somatically in my body, and what needs I have. When I discover my needs, I am in a powerful position to get my needs met. If I do not know what I need in real time, I may react and sabotage my needs which disconnects us from ourselves and other people in our lives.

All attacks are unskilled ways of trying to get a need met. Attacks create disconnect and defensiveness. Using NVC helps us accept influence and stay connected even through some of the most difficult conversations.

NVC not only challenges us to change the way we talk to one another, it also challenges us to change the way we think and perceive the world around us. In other words, NVC is not just a process of communication where words are simply exchanged. We must reframe our thinking so that we are able to genuinely express ourselves and be empathetic to what others are observing, feeling, needing, and requesting. NVC is truly an amazing process that empowers us to connect with one another in a compassionate way.

How to Calm The Jackal and Put on Your Giraffe Ears

Marshall Rosenberg conceptualized our tendency toward aggression and dominance as a jackal, while our more compassionate side he imagined as a giraffe (since giraffes have the largest hearts of all land mammals). When we listen with Jackal ears, we hear complaints as criticisms and requests as demands. When faced with a demand, collaboration isn’t possible. You either submit or you rebel which disconnects us and neither feels good, nor works well in a long-term relationship.

Conversely, when we put on our Giraffe ears, we listen with more empathy and compassion. We are more likely to hear the feelings and the needs behind what someone is saying. We’re more likely to see those needs as being understandable and reasonable, and not in competition with our own needs. When we understand and empathize, compromise and collaboration become feasible.

Nonviolent Communication in Couples Therapy

With couples, NVC bridges the gap in understanding between each partner and helps counter the judgmental negative stories that may build up about the other person:

“They’re lazy.”

“They’re not putting in as much work as I am.”

“They don’t love and care about my feelings.”

These interpretations or evaluations discourage us from being vulnerable and trusting the other person, and they prevent us from making needed changes. When we choose to replace those judgmental stories with greater understanding, more connection is possible.

NVC may challenge our preconceived notions about others and the world, which can help us to appreciate one another and live more freely. When the guy who is cutting me off in traffic stops being a jerk and becomes a person going through something terrible in their own life, I am able to let go of my anger. When I recognize that my difficulties in keeping my home clean aren't "laziness" but rather a battle for motivation or a desire for "rest and recuperation," the self-compassion I gain not only lessens my suffering, but it also increases the likelihood that I will be able to satisfy that need AND keep my house clean.

Whether you’re looking for Couples Therapy or Individual Counseling, Nonviolent Communication (NVC) can help you create the life you want to live together as a team.

Nonviolent Communication Skills in Intimate Relationships

“NVC requires us to be continually conscious of the beauty within ourselves and other people. ”

– Marshall B. Rosenberg, PhD.

The connection between Nonviolent Communication and Intimate Relationships is strong and vital — and perhaps not obvious to those unfamiliar with NVC.

For those of us with NVC skills who are also in intimate relationships, we can’t imagine being in a relationship without NVC!

Intimate relationships are some of the most meaningful connections with the people who are most important to us.

This is why when disconnection happens it can be more painful than in other types of relationships.

In intimate relationships the stakes are higher, in part because our emotional investment is greater.

For all these reasons and more, learning NVC skills to prevent and resolve misunderstandings and conflicts in intimate relationships can help us deepen and enjoy those relationships more fully!

The Importance of Communication in Intimate Relationships

An intimate relationship without communication is like a bird without wings, or a tree without leaves. Communication is one of the primary mediums for connection, and without connection how intimate can a relationship be?

The importance of communication in intimate relationships — now, today —can be summed up by the proverb: “dig your well before you’re thirsty.”

What does this mean?

In this metaphor, thirst is the need for connection, for mutual understanding, for the trust and good will that take us to mutually satisfying ways of living. The well would be access to NVC tools and the practice to become skillful with them.

Your NVC skills can take you to mutual understanding and deeper connection — consistently!

However — there is a big difference between having a tool and being skillful with it.

Can you understand why it might serve NOT to wait until you’re in a full-blown conflict to decide that you want to develop your communication skills?

Communication helps us each know where we’re at, what we’re each feeling, what’s important to us, and what we would like.

There’s another apt proverb here: “An ounce of prevention equals a pound of cure.”

The importance of communication in intimate relationships goes way beyond resolving conflicts.

As you develop your skills you begin to prevent misunderstandings and conflicts. And this allows you to conserve mental and emotional energy, and prevent angst and suffering.

Beyond misunderstandings and conflicts, the importance of communication in intimate relationship is that it contributes to an ongoing deepening of your most important connections.

Common Communication Problems in Relationships

There are many common communication problems in relationships.

Fortunately, NVC has principles, insights, and tools that address every one of them!

One of the most common communication problems in relationships is when we listen to respond rather than to understand.

When you are present, and listening to understand, you will still have a chance to respond later! But first, help the other person experience being understood. This is not the same as agreement; simply understanding.

When the other person feels understood they are much more open to hearing you out! And the dynamic of hearing each other deeply as each person reveals vulnerably, allows the conversation to deepen to a place of authentic connection in which conflicts often resolve themselves.

Sometimes you might be in a conversation that is going just fine, and a little while into it you and the other person find yourselves in a very uncomfortable place — a disagreement, a disconnection, or even a full-blown conflict — and you’re wondering, how did we get here?

This is actually quite a common experience, and is related to the previous communication problem. Sometimes there is even a slight miscommunication — for example one person says red and the other hears blue — and nobody notices.

These situations easily lead to misunderstandings which can lead to conflicts.

A true-life example: a woman said to her male partner, “I don’t want to be so wifey.”

What she meant: “I don’t want to be the only one doing the housework.”

What he heard: “I don’t want to be married to you anymore.”

This couple ended up divorcing — true story — and is an example of a small miscommunication that can spiral out of control quickly if we don’t catch it. So slowing down, listening to understand, and asking clarifying questions can save us all a lot of heartbreak! (In the example of the couple above, their large group of friends also went through a form of heartbreak.)

Another common communication problem in relationships is rushing to a solution in a way that skips the connection. Often the person who does this has positive intentions of wanting to resolve an issue or fix a problem.

However, when we skip the connection the other person rarely feels included in the solution. Furthermore, we have little guarantee that the solution will meet their needs because we haven’t taken the time to find out what they are! NVC encourages us to connect first — get clear on each person’s observations, feelings, needs, and requests — and then, once the needs are clear and there is mutual understanding, together arrive at a strategy that meets all or most of the needs.

Connection before solution!

Nonviolent Communication is also known as life-connected, life-serving communication. As such, it has its opposite: life-disconnected, life-alienating communication, which is defined as the type of thinking and language which takes us away from the quality of connection for which we are seeking.

Most of the common communication problems in relationships can be identified in this life-disconnected thinking and language. These include:

Diagnosing others: This includes judgments, name-calling, and criticism. Diagnoses also include assuming we know what another person is thinking, feeling, or needing. (“You’re obviously very angry about that!”) And they include any static language that would explain why someone is acting the way they are (the problem with you is you are [an egomaniac; an Aries; a troubled soul; a rebel, etc.]).

Denying responsibility: This includes any language that implies that we lack choice. I had to. I had no choice. You made me. I can’t. This does not mean that we always like the options of which we’re aware. Sometimes we dislike every option, and yet, within that we still have choice. And sometimes we’re not aware of other possibilities because we are in a “crisis of imagination.” Rather than owning our choices we act as if we are powerless. I have no choice, it’s (the law, company policy, superiors’ orders). Accusatory blame would fit in this category.

Placing demands on others: In NVC we take responsibility for what we are wanting by expressing clear requests. In a request, the other person’s needs matter too, and so no is an option. In a demand, ‘no’ is not an option. In a demand, by definition, the other person’s needs do not matter equally to the person issuing the demand. The reason this hurts relationships is that, if I am on the receiving end of demands it communicates that my needs don’t matter. This, in turn, leads to resentment and disconnection. Over time, it is quite likely that the needs of the person placing the demands cease to matter to the person on the receiving end.

Life-alienated motivations: The key insight here can be summarized by a phrase often emphasized by Dr. Marshall Rosenberg, creator of NVC: The energy with which we do anything for each other is just as important as the action itself. Life-alienated motivations include fear, guilt, shame, duty/obligation, to obtain an extrinsic reward, to avoid punishment, or acting out of “shoulds” or have-tos.” When we do something for each other out of these motivations, it creates disconnection, resentment, and serves to break down trust. We want to do things for each other when we are connected to how it serves life, how it also contributes to our needs.

Using Compassionate Communication in Relationships

The key to using Compassionate Communication in relationships consists of remembering three things: Purpose, Intention, and Attention.

It’s extremely helpful to remember that the purpose of Compassionate Communication (another name for NVC) is to create a high quality of connection out of which people naturally and spontaneously enjoy contributing to one another’s well-being. This is how we find win-win or mutually satisfying outcomes: out of the connection.

The purpose is not to get others to do what you want, or to get your way, or to get a particular thing to happen!

So when you enter a conversation or are in an interaction, remember that the purpose is first to connect.

And so it helps if this is our intention.

When connecting with another, check your intention. What do I want here? Is my intention to be right? Am I willing to let go of being right and my preferred outcome in order to connect first? Do I trust that once we connect we can together find a mutually agreeable outcome?

And one of the outcomes of developing in NVC is skillful deployment of your attention.

Using Compassionate Communication in relationships means being able to put our attention on feelings and needs, rather than on who’s right and who’s wrong. It means putting our attention on our own, and the other person’s, humanity in order to connect and find a way of being with each other that is mutually fulfilling.

This is how using Compassionate Communication in relationships teaches us to use purpose, intention, and attention to create deeper and more satisfying relationships.

Using NVC to Improve Communication in a Relationship

Using compassionate communication in relationships is simple, though it is not necessarily easy.

The reason is that it helps us become aware of and re-configure old, unconscious patterns that get in the way of the quality of connection we’re looking for. Sometimes discovering these old patterns is painful, and shifting them can take time.

The good news is that as you get better at it, it becomes more fluid and takes less time.

How do we do it?

First, a clarification. We can think about communication in intimate relationships as consisting of a spectrum:

In this simple diagram, we can see that informal NVC could be indistinguishable from a normal conversation. That’s because connection is happening — which after all is the purpose of NVC.

At the other end of the spectrum we see “formal” NVC, which has certain key differentiations and follows a particular structure and syntax. Formal NVC keeps our communication extra clear, and helps us keep the key differentiations clear in our mind.

The dance of connection refers to the steps we take to move toward connection. A simple mnemonic device is ABABAB, referring to person “A” and person “B.”

Here’s how “the dance of connection” works:

1) Person A speaks with honesty from the heart.

2) Person B reflects back their understanding of what Person A said.

3) Person A confirms they were heard accurately.

4) Person B speaks with honesty from the heart.

5) Person A reflects back their understanding of what Person B said.

6) Person B confirms they were heard accurately.

7) Return to the top, to #1. This process is continued until the two people feel connected and they trust that they are understood by the other. Then they can proceed to brainstorm or propose strategies and/or solutions.

Though somewhat of an oversimplification, this illustrates the process we undergo to allow a conversation to wind deeper and deeper, until there is a high quality of connection out of which people co-create mutually satisfying outcomes.

Dr. Marshall Rosenberg on Nonviolent Communication Skills in Relationships

There is so much we can learn from Dr. Marshall Rosenberg on Nonviolent Communication Skills in relationships.

He knew that intimate relationships are some of the most important relationships — and sometimes some of the most challenging ones.

Dr. Rosenberg explained that if you meet your needs at the expense of another, your needs will also not be met. Anytime you create a win-lose, you also lose — because we are all interconnected, interrelated, and interdependent.

When we coerce others or place demands on them, the quality of the connection suffers.

When we can let go of being right and put our attention on making life more wonderful, then we can create a high quality of connection out of which it’s easy to explore outcomes, solutions, and ways of living that are mutually satisfying.

Content by PuddleDancer Press. Use of content okay with attribution. Please visitwww.nonviolentcommunication.comto learn more about Nonviolent Communication.