Which insurance companies does Thrizer work with?

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Overview

Thrizer works with many commercial insurance companies and benefit administrators that have appeared in Thrizer claims before. However, an insurance company name by itself does not guarantee out-of-network benefits, claim approval, or reimbursement for a client’s specific plan. The best next step is to run a benefit check for the client’s specific plan. If the automatic benefit check does not work, Thrizer may be able to review the client’s insurance manually. Manual review uses the front and back of the insurance card and the client’s date of birth.

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Why the insurance company name is not enough

Insurance coverage is determined at the plan level, not just the insurance-company level. For example, two clients may both have the same insurance company, but their plans may have different:

• out-of-network benefits
• deductible rules
• coinsurance
• reimbursement rules
• behavioral health benefit administrators
• claim-processing requirements

A listed insurance company means Thrizer has seen claims involving that insurer before. It is not a statement that Thrizer is in-network with the insurer. It is also not a guarantee that any specific plan from that company will work, be reimbursed, or support Thrizer Pay.

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Common insurance companies clinicians ask about

Thrizer has prior claim experience with many commonly requested insurers and benefit administrators, including: This is not a complete list. See the appendix below for a broader reference list.

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How to check a specific client’s plan

To check whether a client’s plan can be used with Thrizer, run a benefit check using the client’s insurance information. A benefit check usually requires:

• insurance company
• member ID
• client date of birth
• client name
• other subscriber details, when applicable

A successful benefit check may return estimated out-of-network benefit information, such as deductible, coinsurance, estimated reimbursement, and estimated out-of-pocket cost. Benefit-check results are estimates. Final coverage, allowed amount, deductible application, claim approval, and reimbursement are determined by the insurance carrier after the claim is processed.

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If the automatic benefit check does not work

An unsuccessful automatic benefit check does not necessarily mean the client lacks coverage. Automatic checks can fail or return incomplete results for several reasons, including:

• the client’s information does not match insurer records
• the insurance company returns incomplete benefit details
• the plan does not support real-time benefit checks
• the plan requires phone verification
• behavioral health benefits are managed separately
• out-of-network benefit details are not exposed digitally

If this happens, Thrizer may need to verify benefits manually. For manual review, send:

• front of the client’s insurance card
• back of the client’s insurance card
• client date of birth

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If the insurance company is not listed

If an insurance company is not listed, that does not automatically mean Thrizer cannot work with it. It may mean:

• the company is outside Thrizer’s prior claim experience
• the company uses a different administrator or network name
• the plan needs manual review
• the insurer name needs to be entered differently
• the client’s card needs to be reviewed to identify the correct payer

In that case, send the client’s insurance card and date of birth to Thrizer support so the plan can be reviewed.

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Special cases

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Blue Cross Blue Shield plans

Blue Cross Blue Shield plans can be especially plan-specific. The most helpful starting point is the client’s BCBS home plan listed on the insurance card. If the card shows a specific BCBS plan, such as Regence, Premera, Horizon, or BCBS of Massachusetts, use that plan name when checking benefits. Do not assume the client’s plan based only on the client’s location, the clinician’s location, or the general phrase “BCBS.”

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Kaiser Permanente plans

Kaiser Permanente is region-specific. If a client says they have Kaiser, the region matters. Examples include:

• Kaiser Permanente Northern California
• Kaiser Permanente Southern California
• Kaiser Permanente Colorado
• Kaiser Permanente Washington
• Kaiser Permanente Northwest
• Kaiser Permanente Mid-Atlantic
• Kaiser Permanente Georgia
• Kaiser Permanente Hawaii

Kaiser plans often require extra review because plan structure and out-of-network benefit availability can vary.

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Medicare, Medicare Advantage, and Medicaid

Medicare, Medicare Advantage, and Medicaid generally do not include out-of-network benefits in a way that Thrizer can support automatically. Medicare Advantage and other commercially administered Medicare-related plans typically require manual benefit verification. The plan name alone (for example, “UnitedHealthcare Medicare Advantage” or “Aetna Medicare”) is not enough to confirm support. If a manual benefit check returns usable out-of-network benefit information and payment eligibility rules are met, Thrizer payment options may be available.

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HMO plans

HMO plans generally do not include out-of-network benefits, but rare plan-level exceptions may exist. If a benefit check returns usable out-of-network benefit information, or if the result appears inconsistent with the plan type, the plan should be reviewed before drawing a conclusion.

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What insurance-company support does not mean

Insurance-company support in Thrizer does not mean:

• the client has out-of-network benefits
• the client’s deductible has been met
• the client is eligible for Thrizer Pay
• the claim will be approved
• the claim will be reimbursed
• the reimbursement amount is guaranteed
• the insurer will process the claim in a specific way
• the insurer will route reimbursement through Thrizer
• the plan will support every CPT or diagnosis code

Those decisions depend on the client’s specific plan and the insurance carrier’s claim-processing rules.

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What to avoid

Avoid telling clients that Thrizer “takes” or “accepts” their insurance in the same way an in-network provider does. Avoid telling clients that their insurance company is supported without checking their specific plan. Avoid using a listed insurer as a guarantee of reimbursement. Avoid assuming that PPO, HMO, Medicare, Medicaid, BCBS, or Kaiser plan behavior is the same across all clients.

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