Understanding the Out-of-Network Coverage Summary

When you check benefits through Thrizer, you receive a summary of your out-of-network coverage for therapy. At Thrizer, co-pay means the estimated amount you pay at the time of the session. It is based on your out-of-network benefits and includes Thrizer’s fee. It is not the fixed copay listed on an insurance card.

Because out-of-network claims are finalized by your insurer after processing, your co-pay is an estimate, not a guarantee.

Key terms in your coverage summary

Allowed amount

The allowed amount is the maximum amount your insurance plan will consider when calculating reimbursement for a therapy session. This may be different from your clinician’s session fee.

Deductible

Your deductible is the amount you must pay out of pocket before your out-of-network insurance coverage begins.

Co-insurance

Co-insurance is the percentage of the allowed amount you are responsible for paying after your deductible has been met.

Estimated reimbursement

Estimated reimbursement is the amount your insurance is expected to pay toward a session based on your plan details. This is an estimate, not a guarantee.

How your co-pay is calculated in Thrizer

Your co-pay is calculated using:

• Provider fee (the clinician’s session fee)
• Expected insurance reimbursement (based on allowed amount, deductible status, and co-insurance)
• Thrizer fee (a percentage fee)

Co-pay = Provider fee − Expected insurance reimbursement + Thrizer fee

This is designed so you pay your estimated responsibility upfront (plus Thrizer’s fee), instead of paying the full session fee and waiting for insurance reimbursement.

Example

• Provider fee: $200
• Expected insurance reimbursement: $175

Your estimated responsibility is $25.
Thrizer’s fee is $10 (5% of the $200 session fee).

Estimated co-pay charged: $35

Important notes

• All benefit information and co-pay amounts shown are estimated, not guaranteed.
• Final reimbursement is determined by your insurance carrier after claims are submitted.
• Your co-pay may change as deductible status and insurer responses update.
• Expected insurance reimbursement is based on your plan’s allowed amount, deductible status, and co-insurance percentage. These details are explained in your coverage summary.

If you have questions about how your co-pay was calculated or how a claim was processed, support can help walk through it with you.