The evolving landscape and it's impact on Thrizer

This update is directly from Thrizer’s founders, Raunak and Sanjana.

We’ve shared a lot of updates recently in regards to changes and restrictions with certain insurance plans, namely Blue Cross Blue Shield. As many of you are aware, these plans have mandated a switch over to reimbursement via check for any out-of-network sessions.

To clarify: you can still use Thrizer to bill BCBS and submit claims with every transaction. Two things have changed: you must now be registered with BCBS as a non-participating provider for claims to be reimbursed, and clients will receive reimbursements directly from their insurance by paper check — not through Thrizer Pay or direct deposit.

Today, we want share the reason behind these changes, and to do that, we'll need to talk a little bit about how Thrizer works and has attempted to solve the problems in the out-of-network space.

Thrizer’s approach to solving OON

As you know, Thrizer was founded on the principle that mental and behavioral clinicians shouldn't be the ones that suffer due to the broken health insurance system. That was often the case when clinicians accepted lower pay and administrative burden in order to accept insurance and make their services affordable to individuals.

Many companies took the approach of making going in-network easier. Thrizer took a different approach. We believed that out-of-network benefits were a powerful alternative to in-network coverage, one that placed much less burden on private practice clinicians. The patient's out-of-pocket cost still reduced significantly without the provider needing to undertake the hassle of going in-network, waiting to be paid, or accepting lower rates.

However, effectively getting reimbursed for out-of-network claims was not a smooth experience either. Both of us have seen private pay therapists for years and had an intimate experience with the out-of-network claims process, particular how frustrating and burdensome it is for individuals to get reimbursed. Our goal was to make out-of-network benefits much simpler, faster, and more transparent.

There were several ways we did this. One of the most important was our approach to registrations and enrollment. As you're seeing with Blue Cross Blue Shield, the standard process when billing out-of-network was for providers to get pre-enrolled / registered with the insurance company, so they can verify you prior to processing claims that you or your clients submit.

While the requirement makes sense in theory, in practice it was just another hoop for providers to jump through - one that was opaque, manual, and took hours of work. Thrizer’s product abstracted the complexity away by offering automated verifications and enrollments behind the scenes, and including ourselves on the claims’ billing fields along with the rendering provider’s name and NPI.

Through this process, we were also able to enable electronic funds transfer for OON claims. In other words, clients could be reimbursed via direct deposit rather than just mailed check. This was a leap forward because bank payments are much faster and more transparent. This allowed clients to access their coverage with less friction, and allowed Thrizer to offer features like Thrizer Pay. For many insurance plans, this worked and continues to work very well.

BCBS has always been the problem child here, repeatedly pushing back and making it harder for patients and providers to access Thrizer as a resource. It was always a complex undertaking, as BCBS has around 100 sub-plans under its umbrella, each with their own processes and guidelines.

Earlier this year, BCBS no longer accepted our billing structure, began denying claims without warning, and demanded Thrizer remove itself from future claims and pay a large fine for the past claims submitted under this structure. We’ve spent months fighting back to no avail.

Moving forward, they will be requiring practices to directly register with their local BCBS plan rather than allowing Thrizer to facilitate the process. All claims submitted will not have any Thrizer-related information - only your practice’s and provider’s information - which is why BCBS requires you to directly register so they have your practice information on file.

Unfortunately, since we are largely removed from the registration and reimbursement process, we are unable to offer direct deposit or Thrizer Pay for these plans.

We know this hasn’t been easy for you or your clients. We appreciate the trust you’ve placed in us as we’ve all navigated these tough times. We’re going to continue to do everything we can to provide innovative solutions and vastly improve the out-of-network experience with BCBS plans.

Impact on Thrizer and upcoming changes

We won’t pretend that these changes don’t have a profound impact on us as a company.

The mandates by the insurance plan have severely impacted Thrizer's ability to make revenue under the current model, because the majority of our revenue came from bank reimbursements and Thrizer Pay. When plans specifically prohibit that, we do not earn the money required to sustain our operations.

We've operated on razor-thin margins with very little room for error for years. Because of our decision to not raise institutional capital, like venture capital funding, this meant we went years and years without ever hiring an employee. If you remember the glory days of ’23–’24 - the constant product glitches and long email chains with Raunak - you know how far we’ve come.The idea was that if we could get enough practices on the platform and keep costs low, then we could sustain the business without changing prices or raising external funding.

However, due to the recent demands from BCBS and related payers, it has become clear that our operations, product, and business model—everything—must evolve for Thrizer to survive and thrive. That includes our pricing.

We don’t have a pricing update for you today but we will in the coming weeks. We promise to communicate any changes well in advance to give your clients a generous grace period to decide if Thrizer still works with their finances. We also promise to always price fairly and proportionally to the value we provide while also being considerate to the effort that our team puts in.

Our incredible team of 6 is still as committed as ever to keep Thrizer bootstrapped. We want to protect our values, pricing, and mission without the pressure to grow at all costs.

What’s next

Thrizer started as the naive dream of two long-time therapygoers who wanted to make out-of-network benefits easier than they’d been for us. Nearly five years later, despite knowing what we know now, we’d choose this mission again in a heartbeat. We’re not backing down.

We still believe with all our hearts in the power of out-of-network benefits. We believe they will continue to play an important part in access to quality healthcare in the United States.

But most of all, we believe in the ability of modern fintech to greatly improve the ability for private practices to provider high quality and accessible health and wellness services. Our job at Thrizer is to continue to find innovative ways for providers to get paid fast and in full while enabling their clients to leverage a variety of ways, including their health plan coverage, to comfortably access those services.

We don’t know what the future holds and we know we aren’t perfect. We’ll make our fair share of mistakes, just as we have over the past 4.5 years. But we’re in this for the long haul, and we’re incredibly grateful that you’ve chosen to stick with us and be part of this journey. We will never take that for granted.

Thrizer is going to continue to be the leader in this space for years to come, and we're super excited to continue to innovate with you all.

- Raunak, Sanjana, & the entire Thrizer team