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An insurance reimbursement is a payment issued to you by your insurance to help cover a medical service (in this case therapy) rendered by a provider that is not in your insurance's network. Reimbursements are issued for these services once your out-of-network deductible (if any) is met. If you have questions on how to check your specific out-of-network benefits for therapy, visit this article.
For out-of-network services, you will generally pay the provider's fee upfront, submit an insurance claim, and wait for reimbursement. This document outlines how insurance reimbursements work.
Note that with Thrizer, you can just pay your co-insurance portion for out-of-network services, while we submit the claim and wait for reimbursement on your behalf.
The amount you are reimbursed by your insurance for therapy depends on your allowed amount for therapy and any co-insurance or co-pay that you have. Your insurance will always reimburse based on the lower amount between your allowed rate and your billed amount (i.e., the amount your provider charged you).
Any co-insurance or co-pay owed is then subtracted from the allowed amount or billed amount (whichever is lower) to make up your final reimbursement rate.
Example 1:
Example 2:
Reimbursements issued by your insurance will be routed to your bank account directly when using Thrizer. They will automatically be sent to the bank account you connect to Thrizer via the Reimbursement Method section of your Account Settings.
In rare scenarios, your insurance may mandate that reimbursements should be sent to you directly in the form of a check. In this case, you will be notified by our team and should expect to receive checks to the address that you have in the Insurance Information section of your Account Settings.
Reimbursement times vary widely by insurance company. Major payers, such as United Healthcare, Aetna, Cigna, and certain BCBS plans often process claims and issue reimbursements within a week of the appointment. Other, smaller payers may take up to 4 weeks to process claims.
Delays to your reimbursements are rare, but may happen. For most claim issues, our team is notified immediately and they are quickly rectified. If you feel your reimbursements are delayed for any reason, please reach out to help@thrizer.com for prompt assistance.
