Heather Koledo, LMFT

Heather Koledo, LMFTHeather Koledo, LMFTHeather Koledo, LMFT

Heather Koledo, LMFT

Heather Koledo, LMFTHeather Koledo, LMFTHeather Koledo, LMFT
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Superbills or Receipts for HSA/FSA Reimbursement are Available

Find out more

Reimbursement Form

Please complete the Patient section and email it to me. I will complete the remaining sections and return to you for your signature. 

You can then submit this form to your insurance or HSA/FSA. 

Superbill Template (pdf)

Download

Do You Want Insurance Reimbursement?

A SuperBill is an itemized receipt that includes information needed by insurance companies for out of network reimbursements. I am happy to provide a SuperBill to you on a quarterly or semi-annual basis so that you can request reimbursement for your therapy payments. SuperBills can also be used to document payments made from a health or flexible spending account (HSA/FSA).  Important: it is your responsibility to determine what benefits are offered by your insurance carrier for out of network providers.

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Heather Koledo, MA LMFT

603-634-8393

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