Overview
Use these short definitions when discussing a client’s payment, benefit check, or claim. Follow the links for details and next steps. Definitions do not establish coverage or a particular outcome; the insurer determines final coverage, claim approval, reimbursement, and deductible application.Billing Types
OON Billing
The Billing Type for eligible out-of-network claim submission through a successful Thrizer charge. A separate Reimbursement Method determines how reimbursement is handled.Self-Pay
The Billing Type where Thrizer does not submit an insurance claim for the charge. See Billing types for complete requirements and selection steps.Reimbursement Methods for OON Billing
Check
The insurer sends any reimbursement directly to the client/member by mailed check.Bank
Reimbursement routes through Thrizer to the client’s linked reimbursement bank.Instant Reimbursement
For charges submitted from November 2 under standard pricing, an eligible client pays estimated responsibility plus the practice’s OON billing fee, while Thrizer advances the remaining appointment price to the clinician. The practice’s client-facing fee is separate from Thrizer’s fee deductions. Insurance reimbursement goes to Thrizer. “Instant” does not describe insurer processing speed. See Reimbursement methods for upfront payments, destinations, and method-specific conditions, and Pricing overview for fees and effective dates.OON billing prices and fees
For charges submitted from November 2, 2026 under standard pricing:Appointment price
What your practice charges the client for the clinical appointment, excluding your practice’s OON billing fee.OON billing rate
The editable setting for “OON Billing – Check or Bank” or “OON Billing – Instant”. It determines the practice OON billing fee charged to the client.Practice OON billing fee
What your practice charges the client for OON billing support. It is separate from the appointment price and from fees Thrizer charges your practice.Thrizer OON fee
The fee Thrizer charges your practice for the applicable OON Billing method: “OON Claim fee” for Check or Bank or “Instant Reimbursement fee” for Instant Reimbursement. Only the applicable fee applies to a charge.Transaction fee
Thrizer’s card-processing fee charged to your practice. Even when your practice’s OON billing rate matches Thrizer’s OON fee, the client-facing fee and Thrizer’s fee are separate amounts with different payers, recipients, and purposes. See Pricing overview for defaults and examples.Cost and reimbursement terms
Provider fee
The clinician’s full session rate for the Service.Allowed amount
The amount the insurer recognizes for the service. Before processing it is estimated; the insurer determines the final amount.Deductible
The amount the client pays toward eligible services before insurance begins reimbursing them under the plan’s rules.Deductible status
Whether the deductible is met or unmet. Benefit information can give an initial estimate; insurer-reported claim results can update it.Coinsurance
The client’s percentage share after any remaining deductible is applied. It is not the client’s total session responsibility.Estimated reimbursement
A predicted insurer payment based on information available before the claim result.Estimated out-of-pocket responsibility
The predicted appointment price remaining after estimated reimbursement, before the practice’s OON billing fee.Reimbursement
Money insurance pays after processing a claim. The selected method determines its destination. See Deductibles, coinsurance, and allowed amounts for the complete calculation, including why it starts with the lower of the fee and allowed amount.Claims terms
Insurance claim
A request to an insurer for reimbursement or deductible credit for a healthcare service, including client, provider, service, diagnosis, and billing details.Claim status
The processing state, such as Processing, Investigating, Approved, Denied, or Rejected. Approved does not itself prove reimbursement or completed payment.Claim result
The financial outcome, including reimbursement and deductible application. It is separate from status.Reimbursed
The insurer paid an amount after deductible application and coinsurance.Applied to deductible
The claim was approved but the full amount used for reimbursement went toward remaining deductible instead of cash reimbursement.Denied
The insurer did not approve the claim; no reimbursement or deductible credit results.Rejected
The clearinghouse or payer turned the claim away before reviewing coverage. It is different from a denial. See Claims processing timeline for complete status explanations and follow-up, and Support review for charge or claim edits when a submitted detail is wrong.Coverage and benefit terms
Out-of-network benefits
Insurance benefits for care from providers outside the plan’s network. They do not guarantee payment for a specific claim.Coverage estimate
A predicted reimbursement or cost value using available benefit information.Primary insurance on file
In Thrizer’s verification terminology, the client’s primary insurance has been verified. This alone does not establish specific coverage, reimbursement, or available billing options.Eligibility
Confirmation through a usable benefit check that the plan can be used in Thrizer, subject to the applicable clinician, charge, payer, and method requirements.Usable benefit check
A check with enough verified information to establish plan support. A partial response or technically successful request is not enough by itself. Use What is a benefit check? for the complete distinction and Insurance eligibility for limitations.Successful claim
A claim the insurer reviewed and approved rather than denied. It can produce reimbursement or deductible credit, while payment delivery and other financial updates may still be pending. It is not a guarantee of the same result on future claims.Why estimates can change
The final allowed amount, remaining deductible, or claim decision can differ from the estimate. Use Why reimbursement can differ from an estimate for the full causes and practical next steps.Related articles
Deductibles, coinsurance, and allowed amounts
Learn how deductible status, coinsurance, and allowed amounts affect what a client may pay or receive back.
Reimbursement basics
Understand how out-of-network reimbursement works and why insurance determines the final amount.
Why an approved claim may not pay reimbursement
Learn why an approved claim can still result in $0 reimbursement when deductible rules apply.
Why reimbursement can differ from an estimate
See why estimated reimbursement may change after insurance processes a claim.
Which billing options are available?
Compare Self-Pay or OON Billing with an available Reimbursement Method in plain language.