How OON Pay works

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Short answer

OON Pay is for out-of-network care where the client pays the full session fee upfront and Thrizer submits the insurance claim. If insurance reimburses the claim, the reimbursement is sent back to the client through Thrizer. OON Pay can be used before or after the client has met their deductible. The client’s deductible status affects whether reimbursement is likely and whether Thrizer’s OON Pay fee applies, but reimbursement is still decided by insurance. Thrizer does not guarantee that a claim will be approved, reimbursed, or paid by a certain date.

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How OON Pay works

With OON Pay:

• the client pays the full session fee upfront
• Thrizer submits the out-of-network claim after payment succeeds
• insurance processes the claim
• any reimbursement is sent back to the client through Thrizer
• Thrizer’s OON Pay fee applies only after the client’s deductible is met
• the clinician does not wait for insurance to process the claim before receiving payout through Thrizer

OON Pay is different from Thrizer Pay. With OON Pay, the client pays the full fee upfront and receives any reimbursement. With Thrizer Pay, the client pays an estimated amount upfront, and reimbursement is routed to Thrizer because Thrizer advanced part of the session fee.

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Why clients use OON Pay

OON Pay is useful when a client wants Thrizer to handle the out-of-network claim but is still paying the clinician’s full session fee upfront. Without OON Pay, the client may need to pay the clinician directly, collect a superbill, submit the claim to insurance, and track the reimbursement process on their own. With OON Pay, Thrizer helps submit and track the claim after the payment is processed.

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How an OON Pay session works

A typical OON Pay session works like this:

1. The clinician creates a charge for the session.
2. The client pays the full session fee.
3. Thrizer submits the out-of-network claim after the payment is successfully processed.
4. Insurance processes the claim.
5. If insurance reimburses the claim, the reimbursement is sent to the client through Thrizer.

The client does not need to submit a separate claim for an OON Pay session.

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What the client pays

With OON Pay, the client pays the clinician’s full session fee upfront. The client may later receive reimbursement if insurance reimburses the claim. The final reimbursement depends on the client’s plan, deductible, coinsurance, the amount insurance recognizes for the service, and the final claim result.

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Where reimbursement goes

For OON Pay, any insurance reimbursement belongs to the client. That is because the client already paid the full session fee upfront. If insurance reimburses the claim, the reimbursement is routed through Thrizer and sent to the client’s reimbursement account.

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When the OON Pay fee applies

Thrizer’s OON Pay fee is 1% of the clinician’s full session fee. The fee applies only after the client’s deductible is met. Before the deductible is met, no OON Pay fee is charged. After the deductible is met, the fee is deducted from the reimbursement sent to the client. For example, if the session fee is $200, the OON Pay fee is based on$200. It is not based on the amount insurance reimburses.

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What the clinician receives

OON Pay lets the clinician collect payment without waiting for insurance. The clinician receives payout through Thrizer’s payout process. Standard payment processing fees may apply to clinician payment transactions. 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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What happens if the client has not met their deductible

If the client has not met their deductible, insurance may approve the claim but pay $0. That usually means the amount insurance recognizes for the session was applied toward the client’s deductible instead of being reimbursed. This does not always mean something went wrong. The claim may still help the client move closer to meeting their deductible.

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What happens after the deductible is met

After the deductible is met, reimbursement usually depends on:

• the amount insurance recognizes for the session
• the client’s coinsurance
• the final claim result
• any other plan rules

Insurance usually calculates reimbursement from the amount it recognizes for the service, not necessarily the clinician’s full session fee. If the clinician’s fee is higher than the amount insurance recognizes, the difference may remain the client’s responsibility.

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Why reimbursement can differ from the estimate

Any reimbursement amount shown before insurance finishes processing the claim is an estimate. The final result can change because insurance decides:

• whether the claim is approved or denied
• what amount it recognizes for the service
• whether the claim is reimbursed or applied to deductible
• how much reimbursement is paid
• when the claim is processed

An approved claim can still result in $0 reimbursement if the amount is applied to the client’s deductible.

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Important limits

OON Pay is not a guarantee that insurance will reimburse the claim. Thrizer does not guarantee:

• claim approval
• reimbursement amount
• reimbursement timing
• final out-of-pocket cost

OON Pay also depends on complete claim information. A claim generally needs provider information, service information, diagnosis code, CPT code, and billed amount. A single charge generally creates a single claim. Multiple services may need to be handled as separate charges or workflows.

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How to explain OON Pay simply

A simple explanation is:

OON Pay lets the client pay the full session fee upfront while Thrizer submits the out-of-network claim. If insurance reimburses the claim, the reimbursement is sent back to the client through Thrizer. The final reimbursement still depends on the insurance company’s claim decision.

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