For Clients

Understanding Estimates & Reimbursement

Thrizer uses available benefit information to estimate out-of-network costs. These estimates can help you plan for therapy expenses, but your insurance company determines the final claim result and reimbursement amount.

Key Terms

Words Worth Knowing

Provider Fee

The provider fee is your clinician's full session rate.

Allowed Amount

The allowed amount is the amount your insurance company recognizes for a covered service. Insurance reimbursement is generally calculated based on the insurer's allowed amount, which may be lower than the provider's full session fee.

Deductible

Your deductible is the amount you are responsible for paying before insurance begins reimbursing eligible out-of-network services. If your deductible has not been met, an approved claim may be applied toward your deductible and still result in $0 reimbursement.

Coinsurance

Coinsurance is the percentage of the insurer's allowed amount that you are responsible for after your deductible has been met.

Estimates

Why Estimates Can Change

Before a claim is processed, Thrizer estimates the allowed amount and potential reimbursement using available insurance benefit information.

After your insurance company processes an actual claim, Thrizer may update future estimates based on the insurer's actual allowed amount and claim decision.

Because of this, the amount you ultimately receive may differ from the original estimate.

Claim Outcomes

Approved Does Not Always Mean Reimbursed

An insurance claim can be approved and still result in $0 reimbursement if the allowed amount is applied toward your deductible. Claim outcomes generally fall into three categories:

Reimbursed

Your insurance company pays part of the allowed amount.

Applied to deductible

Your insurer approves the claim but applies the allowed amount toward your deductible instead of issuing reimbursement.

Denied

Your insurer does not issue reimbursement or deductible credit.

Reimbursement

Who Receives the Reimbursement?

Where reimbursement is sent depends on the Thrizer payment option used for the session.

OON Pay

With OON Pay, reimbursement is generally sent to you. Some insurance companies may mail a reimbursement check directly to you instead of sending the reimbursement through Thrizer. If Thrizer sends reimbursement directly to you, you should add a reimbursement bank account so Thrizer knows where to deposit the funds.

Thrizer Pay

With Thrizer Pay, reimbursement is sent to Thrizer because Thrizer has already advanced part of the session fee to your clinician.

Deductibles

Does Thrizer Track My Deductible Progress?

Thrizer does not automatically maintain a running deductible balance across all of your claims. Benefit checks estimate your deductible status based on the information available at the time the benefit check is performed. Your insurance company ultimately determines how each claim is applied toward your deductible.

If additional claims have been processed and you want updated deductible information, you may contact Thrizer support and request a manual benefit recheck. For the most current deductible balance, contact your insurance company directly.

Why a Claim May Not Appear to Count Toward Your Deductible

Your insurance company determines how the allowed amount from each claim is applied. Common reasons an out-of-network claim may not appear to reduce your deductible include:

The claim is still being processed.
The claim was denied.
The insurer's allowed amount is lower than the clinician's full session fee.
Your insurance plan has a separate out-of-network deductible.
Your insurance company's deductible records have not yet updated.

Deductible credit is generally based on the insurer's allowed amount rather than the full amount charged by your clinician. If a claim has finished processing and you still have questions about how it was applied, contact your insurance company directly — they determine the final deductible application.

Timeline

Claims Processing Timeline

Insurance claims commonly take several weeks to process. The insurance company controls the actual claim-processing timeline, so Lakeview Counseling & Consulting and Thrizer cannot guarantee when reimbursement will be issued.

Important

Insurance Disclaimer

All insurance benefit information and reimbursement amounts shown through Thrizer are estimates only and are not guarantees of coverage or payment. Your insurance company makes the final determination regarding:

Covered services
Allowed amounts
Deductible application
Coinsurance
Claim approval or denial
Reimbursement amounts
Claim-processing timelines

Clients remain responsible for all charges for services received from Lakeview Counseling & Consulting regardless of insurance reimbursement.

Resources

Learn More About Out-of-Network Benefits

Thrizer provides educational resources to help you understand how out-of-network insurance works.

Check My Insurance Benefits