Which payment and claim submission options are available?

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Overview

Thrizer supports different payment options. Availability depends on whether insurance is involved, whether Thrizer has verified benefits, and whether the client’s deductible is met. Thrizer Pay also requires enough confirmed claim history. 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.

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What options does Thrizer support?

Thrizer supports three ways to pay for out-of-network care through the clinician’s portal. 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 sent to Thrizer.

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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.

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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.

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Which options are available after the deductible is met?

After the deductible is met, OON Pay may still be available. Thrizer Pay may also become available, but only if all required conditions are met. A met deductible alone does not qualify a client. Thrizer Pay also requires:

• Primary insurance.
• A completed benefit check.
• At least one successful prior claim.
• A Date of Service of today or tomorrow (a calendar-day restriction, not a rolling 24-hour window).
• A valid Individual NPI on the rendering clinician.

A successful claim helps Thrizer understand how the client’s insurance actually processes claims, including allowed amount and coinsurance behavior. For the full list of conditions that make Thrizer Pay unavailable even for a post-deductible client, see Why isn’t Thrizer Pay available?.

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Are there insurers where Thrizer Pay and OON Pay direct deposit are not available?

Yes. Thrizer Pay and OON Pay direct deposit are not available for clients on plans within the Blue Cross Blue Shield (BCBS) umbrella. These plans reimburse by paper check directly to the client. Thrizer continues to submit eligible OON Pay claims. For full details, see BCBS reimbursement.

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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 and enough charge information to submit a valid, timely claim. Thrizer Pay may be disabled while other claim submission options remain available in these cases:

• Reimbursement behavior is not confirmed.
• Claim outcomes are unreliable.
• The charge is missing required information, such as a valid Individual NPI or an in-window Date of Service.

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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 option 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 options are available based on the client, clinician, and insurance information on file. Thrizer may support Self-Pay, OON Pay, or Thrizer Pay 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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