Clinician payout protection and clawbacks

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No clinician clawbacks for insurance outcomes

Thrizer’s policy is best described as no clinician clawbacks for insurance outcomes. If a claim is denied, reimburses less than expected, applies to the client’s deductible, or results in $0 reimbursement, Thrizer does not reverse the clinician’s payout because of that claim outcome. Clinician payout timing is also separate from insurer reimbursement timing. The clinician does not wait for insurance to process a claim before receiving payout through Thrizer.

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How this works for Thrizer Pay

This is especially important for Thrizer Pay, because Thrizer advances part of the session fee before insurance finishes processing the claim. With Thrizer Pay:

• the client pays an estimated out-of-pocket responsibility upfront
• Thrizer advances the rest of the session fee to the clinician
• Thrizer submits the claim and receives any insurance reimbursement
• Thrizer carries the reimbursement risk relative to the clinician

If the final insurance result differs from the estimate, the clinician’s payout is still protected. Any adjustment is handled on the client and Thrizer side where applicable — for example, an additional client charge, a client refund, or updated estimates for future sessions. It is not handled by clawing back the clinician’s payout. The clinician’s payout is not reduced later if insurance:

• denies the claim
• reimburses less than expected
• reimburses $0
• applies the claim to the client’s deductible

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How this works for OON Pay

With OON Pay, the client pays the full session fee upfront and any insurance reimbursement is routed back to the client through Thrizer. Because the clinician is paid from the client’s upfront payment rather than from an advance by Thrizer, insurance outcomes also do not reverse the clinician’s payout under OON Pay.

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The main exception: clinician-initiated refunds

The main exception to payout protection is a refund initiated by the clinician. If a clinician chooses to refund a transaction, that refund can reverse the refunded transaction amount from the clinician’s payout. The client is refunded the amount originally charged, and the clinician’s payout is reduced for the refunded amount. This is separate from an insurance-related clawback. It is driven by the clinician’s own refund action, not by an insurer claim outcome.

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What this does not cover

Payout protection is specifically about insurer claim outcomes. It does not mean Thrizer never reverses a transaction under any circumstance. Other situations, such as clinician-initiated refunds described above, can still reduce a clinician’s payout. If you have a question about a specific transaction, reach out to help@thrizer.com.

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