Insurance payment examples

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Overview

Use these examples to walk a client through estimated costs, deductibles, and reimbursement. The numbers illustrate how the calculation works; the insurer decides the actual coverage, allowed amount, deductible application, reimbursement, and timing.

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Before you read the examples

Use the calculation guide for the full definitions and calculation. These examples assume the stated claim decision, appointment price, allowed amount, remaining deductible, and coinsurance are known. Client responsibility below means the appointment price minus insurance reimbursement, before any practice OON billing fee. Current fees and their triggers are maintained in the Pricing overview; the examples do not establish eligibility for a method.

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Example 1: The deductible has not been met

A client has a $200 session. For this example:

• Appointment price: $200
• Insurance allowed amount: $120
• Deductible remaining: $500
• Claim status: Approved

Because the client still has more deductible remaining than the allowed amount, the insurer may apply the $120 allowed amount toward the deductible. In this example:

• Insurance reimbursement: $0
• Amount applied to deductible: $120
• Client responsibility: $200

What this means: an approved claim can still result in $0 reimbursement when the client’s deductible has not been met.

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Example 2: The deductible is partly met during the claim

A client has a $200 session. For this example:

• Appointment price: $200
• Insurance allowed amount: $120
• Deductible remaining: $50
• Client coinsurance after deductible: 20%
• Insurer share after deductible: 80%
• Claim status: Approved

The first $50 of the allowed amount is applied to the remaining deductible. That leaves $70 of the allowed amount after the deductible is met. The insurer then reimburses 80% of the remaining $70. In this example:

• Amount applied to deductible: $50
• Remaining allowed amount after deductible: $70
• Insurance reimbursement: $56
• Client responsibility: $144

What this means: a claim can produce partial reimbursement when part of the allowed amount goes to the deductible and the rest is reimbursed based on coinsurance.

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Example 3: The deductible has already been met

A client has a $200 session. For this example:

• Appointment price: $200
• Insurance allowed amount: $120
• Deductible remaining: $0
• Client coinsurance: 20%
• Insurer share: 80%
• Claim status: Approved

Because the deductible has already been met, reimbursement is based on the allowed amount and coinsurance. In this example:

• Insurance reimbursement: $96
• Client responsibility: $104

What this means: even after the deductible is met, the client may still be responsible for part of the appointment price. That can include the client’s coinsurance and any difference between the appointment price and the allowed amount.

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Example 4: The appointment price is lower than the allowed amount

A client has a $100 session. For this example:

• Appointment price: $100
• Insurance allowed amount: $120
• Deductible remaining: $0
• Client coinsurance: 20%
• Insurer share: 80%
• Claim status: Approved

When the appointment price is lower than the allowed amount, reimbursement is based on the lower amount. In this example:

• Effective amount used for reimbursement: $100
• Insurance reimbursement: $80
• Client responsibility: $20

What this means: when the appointment price is lower, both deductible application and coinsurance use that lower fee. Here, insurance reimburses 80% of $100, not 80% of $120. The payment examples below use standard pricing from November 2, 2026, without waivers or refunds. Defaults apply automatically if unchanged; client-specific or catalog rates may differ. For zero, default and higher-than-Thrizer-fee examples for both methods, see Pricing overview.

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Example 5: OON Billing with Bank after the deductible has been met

A client uses OON Billing with Bank for a $200 session. For this example:

• Appointment price: $200
• Practice OON billing rate: $4 default for Bank
• Assumed insurance reimbursement: $96
• Claim status: Approved
• Reimbursement amount: $96

With Bank, the client pays the full appointment price plus the $4 practice OON billing fee upfront. Thrizer submits the eligible claim after successful payment, once the service date is no longer in the future and the required claim information is complete. If the insurer reimburses the claim through Thrizer, reimbursement is sent to the client’s linked reimbursement bank account. In this example:

• Client pays upfront: $204
• Insurance reimbursement: $96
• Practice OON billing fee: $4 included in the client payment
• “OON Claim fee” (Thrizer): $4
• “Transaction fee” (Thrizer): $6.11
• Clinician payout: $193.89
• Reimbursement sent to client: $96

What this means: with OON Billing and the Bank method, the client pays the appointment price plus the practice’s OON billing fee first and waits for reimbursement. Thrizer separately deducts its applicable “OON Claim fee” and “Transaction fee” from the practice’s proceeds.

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Example 6: OON Billing with Bank before the deductible has been met

A client uses OON Billing with Bank for a $200 session. For this example:

• Appointment price: $200
• Practice OON billing rate: $4 default for Bank
• Insurance allowed amount: $120
• Deductible remaining: $500
• Claim status: Approved
• Reimbursement amount: $0

The client pays the full appointment price plus the $4 practice OON billing fee upfront. The insurer approves the claim, but the allowed amount is applied to the client’s deductible instead of being reimbursed. In this example:

• Client pays upfront: $204
• Insurance reimbursement: $0
• Amount applied to deductible: $120
• Practice OON billing fee: $4 included in the client payment
• “OON Claim fee” (Thrizer): $4
• “Transaction fee” (Thrizer): $6.11
• Clinician payout: $193.89

What this means: before the deductible is met, OON Billing can still include claim submission and tracking, but the client may not receive reimbursement. Thrizer separately deducts its applicable “OON Claim fee” and “Transaction fee”.

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Example 7: Instant Reimbursement when available

A client uses Instant Reimbursement for a $200 session. This example assumes Instant Reimbursement is available for the client. For this example:

• Appointment price: $200
• Practice OON billing rate: $15 default for Instant Reimbursement
• Estimated client responsibility: $104
• Estimated insurance reimbursement: $96
• Claim status: Approved

With Instant Reimbursement, the client pays the estimated responsibility plus the $15 practice OON billing fee when the clinician successfully processes the charge. Thrizer advances the remaining portion of the clinician’s appointment price. Insurance reimbursement is sent to Thrizer. In this example:

• Estimated client responsibility: $104
• Client pays upfront: $119 (estimated responsibility plus the $15 practice OON billing fee)
• Estimated amount advanced by Thrizer: $96
• “Instant Reimbursement fee” (Thrizer): $15
• “Transaction fee” (Thrizer): $3.69
• Clinician payout: $196.31
• Where reimbursement is sent: Insurance → Thrizer

What this means: with Instant Reimbursement, the client does not pay the full appointment price upfront. The final insurer outcome may still differ from the estimate, and that difference may result in an additional client charge or a refund. The practice’s OON billing fee is independent of the “Instant Reimbursement fee” and “Transaction fee” deducted by Thrizer.

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Example 8: The claim is denied

A client has a $200 session. For this example:

• Appointment price: $200
• Claim status: Denied

When a claim is denied, there is no reimbursement and no deductible credit from that claim. In this example:

• Insurance reimbursement: $0
• Amount applied to deductible: $0

What this means: a denied claim is different from an approved claim that is applied to the deductible. An approved claim may still affect the deductible even if no money is reimbursed. A denied claim does not create reimbursement or deductible application.

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Why estimates can differ from the final result

These examples use assumed inputs. The insurer determines the actual allowed amount, deductible application, reimbursement, and claim decision. See Why reimbursement can differ from an estimate before applying the examples to a client’s session.

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