Self-pay and superbills

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Short answer

Self-Pay means the client pays the full session fee without using insurance through that payment flow. No insurance claim is automatically submitted, no reimbursement is routed through Thrizer, and no Thrizer client insurance-related fee applies to the Self-Pay payment itself. Standard card processing fees on the clinician side still apply. A superbill is different. A superbill is a document a client can use to submit claim information separately for possible out-of-network reimbursement or deductible credit. Reimbursement is not guaranteed, and the insurance carrier decides the final claim outcome.

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When would I use Self-Pay?

Self-Pay is used when a session is paid without insurance involvement through Thrizer. With Self-Pay:

• the client pays the full session fee
• no claim is automatically submitted
• no reimbursement is expected through that payment flow
• no insurance information is required for the Self-Pay payment
• no diagnosis code is required for the Self-Pay payment

For example, a client may use Self-Pay when they are not using insurance for the session or when no claim will be submitted through Thrizer.

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Does Self-Pay create an insurance claim?

No. Self-Pay does not create an insurance claim. That means the client should not expect claim tracking, deductible credit, or reimbursement from the Self-Pay payment itself. If the client wants to pursue reimbursement separately, they may need to submit claim information separately, such as by using a superbill.

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What is a superbill?

A superbill is a document with information an insurance carrier may need to process a claim. A valid superbill generally includes information such as:

• provider name
• provider NPI
• tax ID or TIN
• service date
• billed amount
• diagnosis code
• CPT code

The insurer uses the submitted claim information to decide whether the service is eligible for reimbursement or deductible credit.

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Can a client submit a superbill through Thrizer?

Yes. Thrizer supports client-submitted claims through Superbill Upload. This is separate from automatic claim submission through payment flows like OON Pay or Thrizer Pay. With Superbill Upload, the client provides the required claim information, and a claim is generated from the uploaded document. If reimbursement is issued for a Superbill Upload claim, it is sent to the client. Superbill Upload may be useful when:

• the clinician is not using Thrizer for automatic billing
• the visit happened before using Thrizer
• the client paid out of pocket and wants to submit a claim for possible reimbursement

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Can a clinician submit a superbill for a client?

No. Superbill Upload for claim submission is client-driven. A clinician may generate or provide a superbill to the client, but the client is responsible for uploading the superbill or entering claim details through their own Thrizer account.

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Does a superbill guarantee reimbursement?

No. A superbill does not guarantee reimbursement. The insurance carrier decides whether the claim is accepted, denied, applied to the deductible, or reimbursed. Claims may also be subject to the insurer’s timely filing rules. A claim can be accepted by the insurer and still result in no cash reimbursement if the allowed amount is applied to the client’s deductible.

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Is there a fee for Superbill Upload?

Yes. Superbill Upload has a $2 fee per session. If a superbill includes multiple sessions, the fee is$2 × the number of sessions. The fee is charged at the time of submission. If the claim is denied, the fee is refunded. If the claim is approved or applied to the deductible, the fee is retained. No percentage-based client fee applies to Superbill Upload claims.

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How is this different from OON Pay?

With OON Pay, the client pays the full session fee upfront and Thrizer automatically submits the claim after the charge is successfully processed. If reimbursement is issued, it is routed back to the client. With Self-Pay, no insurance claim is automatically submitted. If the client wants to pursue reimbursement, they need to use a separate claim process, such as uploading a superbill through Thrizer or submitting claim information directly to insurance.

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How is this different from Thrizer Pay?

With Thrizer Pay, the client pays an estimated out-of-pocket amount upfront, Thrizer advances the remaining session fee to the clinician, and insurance reimbursement is routed to Thrizer. With Self-Pay, the client pays the full session fee, Thrizer does not advance payment based on insurance, and no claim is automatically submitted.

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What should I expect after submitting a superbill?

After a superbill is submitted, the claim outcome depends on the insurance carrier. The claim may be:

• reimbursed
• applied to the deductible
• denied

The final result depends on the client’s plan, the insurer’s rules, the submitted claim details, and any timely filing limits that apply. Thrizer does not guarantee claim approval, reimbursement amount, deductible application, or claim timing.

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What Thrizer does

Thrizer supports Self-Pay payments where no insurance claim is automatically submitted. Thrizer also supports client-submitted Superbill Upload claims when the client uploads a valid superbill or enters claim details through a supported Thrizer claim workflow.

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What insurance determines

The insurance carrier determines whether a submitted claim is accepted, denied, applied to the deductible, or reimbursed. The carrier also determines the reimbursement amount and claim processing timing.

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