How Thrizer Pay works

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Short answer

Thrizer Pay helps eligible clients avoid paying the full session fee upfront for out-of-network care. Instead, the client pays an estimated out-of-pocket amount based on available insurance and claim information. Thrizer advances the remaining portion of the session fee to the clinician, submits the claim, and receives any insurance reimbursement for that claim. Thrizer Pay can make out-of-network care easier to afford upfront, but it is still based on estimates. Insurance makes the final decision on claim approval, deductible application, reimbursement amount, and timing. Thrizer does not guarantee the final out-of-pocket cost, reimbursement amount, claim approval, or claim timing.

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How Thrizer Pay works

With Thrizer Pay:

• the client pays an estimated out-of-pocket amount upfront
• the client also pays a 5% Thrizer Pay fee
• Thrizer advances the rest of the session fee to the clinician
• Thrizer submits the insurance claim after payment succeeds
• any insurance reimbursement for that claim goes to Thrizer
• the clinician does not wait for insurance to process the claim before receiving payout through Thrizer

Thrizer Pay is not available for every client or every session. It requires enough reliable insurance and claim history for Thrizer to estimate the client’s responsibility.

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Why clients use Thrizer Pay

Without Thrizer Pay, out-of-network clients often have to pay the full session fee upfront and wait for insurance reimbursement later. Thrizer Pay changes that experience for eligible clients. Instead of paying the full session fee upfront, the client pays an estimated responsibility at the time of service. Thrizer advances the rest upfront and waits for insurance reimbursement. This can reduce the client’s upfront cost when Thrizer Pay is available.

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How a Thrizer Pay session works

A typical Thrizer Pay session works like this:

1. The clinician creates a charge for the session.
2. The client pays their estimated responsibility plus the Thrizer Pay fee.
3. Thrizer submits the insurance claim after the payment is successfully processed.
4. Thrizer advances the remaining portion of the session fee to the clinician.
5. Insurance processes the claim.
6. Any insurance reimbursement for that claim is routed to Thrizer.
7. If the final insurance result differs from the estimate, the client’s balance may be adjusted.

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

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What the client pays

With Thrizer Pay, the client pays:

• their estimated out-of-pocket responsibility
• a 5% Thrizer Pay fee

The 5% fee is based on the clinician’s full session fee, not on the amount insurance eventually reimburses. For example, if the clinician’s session fee is $200, the Thrizer Pay fee is based on$200. The estimated responsibility is based on available insurance and claim information. It may use details such as deductible status, coinsurance, and the amount insurance is expected to recognize for the service. Because insurance has not finished processing the claim yet, this amount is still an estimate.

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What the clinician receives

Thrizer Pay is designed so the clinician can receive payout 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

This protection covers insurance-driven outcomes. It does not apply to refunds initiated by the clinician. If the clinician issues a refund for a Thrizer Pay transaction, the clinician’s payout is reversed for the refunded amount, and the client is refunded the amount originally charged.

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Why reimbursement goes to Thrizer

With Thrizer Pay, Thrizer advances part of the session fee before insurance finishes processing the claim. Because Thrizer advanced that amount, any insurance reimbursement for the claim is routed to Thrizer. This is different from OON Pay. With OON Pay, the client pays the full session fee upfront, so any insurance reimbursement is sent back to the client through Thrizer.

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When Thrizer Pay may be available

Thrizer Pay is not available for every client or every session. It generally requires:

• primary insurance information
• verified coverage information
• the client’s deductible to be met
• at least one successful claim, so Thrizer can use prior insurer behavior to estimate the client’s responsibility

If Thrizer does not yet have enough reliable information, Thrizer Pay may not appear as an option. Other claim submission options may still be available.

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Why the estimate can change

Thrizer Pay uses an estimate before insurance finishes processing the claim. 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. After insurance processes a claim, Thrizer may use the actual result to improve future estimates.

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What happens if the final amount is different from the estimate

If the final insurance result differs from the estimate, the client’s balance may be adjusted. Depending on the result, this may lead to:

• an additional client charge
• a client refund
• updated estimates for future sessions

These adjustments are based on insurer-determined claim results. They are not changes to the clinician’s payout.

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What happens if the claim is denied

If the claim is denied, the Thrizer Pay fee is refunded to the client. If the claim is approved, including when the claim is applied to the client’s deductible, the Thrizer Pay fee is retained. The clinician’s payout is not reduced because of the denial. Insurance determines whether a claim is approved or denied. Thrizer helps submit and track the claim, but Thrizer does not control the final insurance decision.

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Important limits

Thrizer 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
• availability of Thrizer Pay for every client

Thrizer Pay also depends on complete claim information. A claim generally needs provider information, service information, diagnosis code, CPT code, and billed amount.

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How to explain Thrizer Pay simply

A simple explanation is:

Thrizer Pay lets eligible clients pay an estimated amount upfront instead of the full session fee. Thrizer advances the rest to the clinician, submits the claim, and receives any insurance reimbursement. The final insurance result can still differ because insurance makes the final claim decision.

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