How Do Benefit Checks Work

The instant benefit calculator is a tool in the Clinician portal that helps estimate out-of-network insurance benefits before starting care.

This article explains how to use the instant benefits calculator in your portal and how Thrizer calculates insurance benefit estimates for therapy and other services.
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What information is used to run a check

To retrieve insurance benefit information, the following details are required:

Insurance carrier
Member ID
Date of birth

These details are standard requirements used by insurance systems to look up eligibility and out-of-network benefits for yourservices.
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How Thrizer retrieves insurance data

Once the information is entered, Thrizer retrieves eligibility and benefits data from insurance systems used by health plans and their partners, including insurance clearinghouses commonly used in healthcare.

These systems return plan-level information such as:

Whether out-of-network mental health benefits are available
Deductible amounts and remaining balances
Co-insurance percentages
Allowed amounts for out-of-network services

Thrizer bases its calculations on the information returned by the insurance plan at the time of the check.
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How benefit and cost estimates are calculated

After retrieving benefit details, Thrizer applies that information to the practice’s rates to estimate:

Expected insurance reimbursement
Estimated out-of-pocket cost per session

The calculation follows standard out-of-network rules, including:

Paying the full session fee until the deductible is met
Applying co-insurance to the plan’s allowed amount after the deductible
Calculating the difference between the insurance reimbursement and the session fee

These estimates help clarify potential costs before care begins.
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Why estimates may change

The instant benefit calculator provides estimates, not guaranteed reimbursement amounts.

Insurance plans finalize allowed amounts or reimbursement rates only after a claim is submitted.

As a result, actual reimbursement may differ from the initial estimate.

Note that this does not impact your payments as a clinician. For your purposes, Thrizer is a standard credit card processor and you will always receive your full rate (no clawbacks ever). We also handle the full paperwork and insurance communications process with Clients.

When claims are later submitted through Thrizer, benefit information updates automatically based on insurer responses.
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What this means in practice

The instant benefit calculator:

Uses insurer-provided benefit data, not averages or assumptions
Applies plan rules to real session fees
Helps clarify costs early in the process
Supports informed decisions before starting care

It is designed to explain how benefits apply, not to replace claim adjudication.
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