Short answer
Thrizer uses available benefit information to estimate out-of-network costs. Those estimates help you plan, but the insurer determines the final claim result.Key terms
Provider fee
The provider fee is your clinician’s full session rate.Allowed amount
The allowed amount is the amount the insurer recognizes for a covered service. Reimbursement is based on the allowed amount, not necessarily the provider fee.Deductible
Your deductible is the amount you pay before insurance starts reimbursing eligible services. If your deductible is not met, an approved claim can apply to your deductible and still pay $0 in reimbursement.Coinsurance
Coinsurance is your share of the allowed amount after the deductible is met.Why estimates change
Before a claim is processed, Thrizer estimates the allowed amount and reimbursement using available benefit information. After the insurer processes a claim, Thrizer updates expectations based on the insurer’s actual allowed amount and claim result.Approved does not always mean reimbursed
A claim can be approved and still result in $0 reimbursement when the allowed amount is applied to your deductible. Claim outcomes generally fall into these categories:- Reimbursed: insurance pays part of the allowed amount.
- Applied to deductible: insurance approves the claim but applies the allowed amount to your deductible instead of paying reimbursement.
- Denied: insurance does not issue reimbursement or deductible credit.
Who receives reimbursement
Reimbursement routing depends on the workflow:- OON Pay: reimbursement is routed to you.
- Superbill upload: reimbursement is routed to you.
- Thrizer Pay: reimbursement is routed to Thrizer for internal reconciliation.