Which payment and claim submission options are available?

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Short answer

Thrizer supports different payment and claim submission options depending on whether insurance is involved, whether benefits have been verified, whether the client’s deductible has been met, and whether Thrizer has enough confirmed claim history to support Thrizer Pay. Self-Pay is available without insurance or a benefit check. OON Pay requires usable benefit information. Thrizer Pay has the strictest requirements because Thrizer advances part of the session cost before the insurance claim is fully resolved. Superbill Upload is different from the payment flows. It lets a client submit a superbill through Thrizer for claim submission.

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What options does Thrizer support?

Thrizer supports several ways to pay for or submit out-of-network care. Self-Pay means the client pays the full session cost and no insurance claim is submitted through Thrizer. OON Pay means the client pays the full session cost upfront, and Thrizer submits an out-of-network claim. If insurance reimburses the claim, reimbursement is sent to the client. Thrizer Pay means the client pays an estimated out-of-pocket amount upfront, plus the Thrizer Pay fee. Thrizer advances the remaining session cost to the clinician, and insurance reimbursement is routed to Thrizer. Superbill Upload lets a client submit a superbill through Thrizer for claim submission. It is a client-submitted claim workflow, not an automatic payment flow.

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Which options are available without a benefit check?

Self-Pay is available without a benefit check because no insurance claim is submitted. OON Pay and Thrizer Pay require usable benefit information. If Thrizer does not have enough benefit information to support claim submission for the client’s insurance plan, those payment methods cannot be used for charging. Superbill Upload may still be available when the client has a valid superbill and submits the claim through a supported Thrizer claim workflow.

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Which options are available before the deductible is met?

Before the deductible is met, Thrizer Pay is not available. If the required benefit information is available, OON Pay may be available before the deductible is met. With OON Pay, the client pays the full session cost upfront. If the claim is approved while the deductible is not yet met, the allowed amount may be applied toward the deductible instead of producing a reimbursement payment. Superbill Upload may also be available before the deductible is met.

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Which options are available after the deductible is met?

After the deductible is met, OON Pay and Superbill Upload may still be available. Thrizer Pay may also become available, but only if all required conditions are met. Thrizer Pay requires primary insurance, the deductible to be met, and at least one successful claim. A successful claim helps Thrizer understand how the client’s insurance actually processes claims, including allowed amount and coinsurance behavior. If those conditions are not met, Thrizer Pay may not be available even if the client appears to be post-deductible.

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Why is Thrizer Pay more limited than OON Pay?

Thrizer Pay is more limited because Thrizer advances part of the clinician’s session fee before the insurance claim is fully resolved. Before making Thrizer Pay available, Thrizer needs enough confirmed information about how the client’s insurance handles claims. If reimbursement behavior is not confirmed, or if claim outcomes are unreliable, Thrizer Pay may be disabled while other claim submission options remain available.

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Does an available payment type guarantee reimbursement?

No. Insurance determines final coverage, claim approval, deductible application, reimbursement amount, and timing. A benefit check or successful claim can help determine whether a payment workflow is available, but it does not guarantee a specific reimbursement outcome. Estimates may differ from the final result after the insurance carrier processes the claim.

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What Thrizer does

Thrizer determines which payment or claim submission workflows are available based on the information available in the system. Thrizer may support Self-Pay, OON Pay, Thrizer Pay, or Superbill Upload depending on the client, insurance, deductible status, benefit information, and claim history.

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What insurance determines

The insurance carrier determines final coverage, claim approval, deductible application, reimbursement amount, and claim processing timing. Thrizer does not guarantee that an available payment or claim submission option will result in reimbursement.

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