Checking Out-of-Network Benefits

Out-of-network benefits is coverage provided by your insurance plan for healthcare services (in this case therapy) received from healthcare providers who are not part of the plan's designated network. These benefits generally include reimbursement for the cost of services obtained outside the network, though there may be limitations or conditions imposed by your plan.

You can find out your out-of-network benefits for therapy a few different ways.


Enter your insurance information in your Thrizer account

Creating your Thrizer account is the fastest and most efficient way to check your out-of-network coverage for therapy. To do so, you would just need to enter your insurance information in your account settings.

Once you enter your insurance information in their Thrizer account, the platform runs an automatic OON benefit check. Both you and your clinician receive the email breakdown of the benefits, which include the deductible amount, co-insurance, and estimated co-payment.

Have your clinician check the OON benefits for you

Your provider can also check your benefits by entering in your insurance information from their account or sending our team your insurance information.

Email our support team

You can email our support team at help@thrizer.com with your insurance card and date of birth. We can check benefits and send you a breakdown within 2 business hours!

Understanding out-of-network benefits

The breakdown of your insurance benefits will include several different terms that are important to know for you to truly understand your net cost for therapy.

Allowed rate: The allowed rate is the maximum amount that the your insurance will accept and reimburse for therapy. It is not necessarily the same as the amount that your clinician charges you.
Deductible: The amount you must pay out-of-pocket before your out-of-network insurance coverage begins.
Co-Payment: A set amount the you pay for each appointment. The applies whether or not you have met your deductible.
Co-insurance: The percentage of costs you pay after you have met your deductible
Estimated Reimbursement: The estimated payment you will receive from your insurance for a therapy appointment.

How reimbursement rates are estimated

The reimbursement rate provided in the benefit check is just an estimate, and is calculated from the your co-insurance and allowed rate for out-of-network mental health services.

We estimate the allowed amount of your insurance plan based on our data and experience with insurances and their allowed amounts for different services. Our estimates are constantly improving and getting more accurate, each time a benefit check is done.

For example, if you have an estimated allowed amount of $100 for therapy, then $100 is what will be applied to the deductible and is the maximum you will be reimbursed. If you have a co-insurance, it would be deducted from that allowed amount of $100. For example, a 20% co-insurance means that you are responsible for $20 and your estimated reimbursement rate would be $80.