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In most cases, Thrizer is able to link to your health plan and show an instant estimate of your out-of-network benefits.
When this does not work, it does not mean you do not have out-of-network coverage. It usually means your insurance plan was unable to return complete information in real time.
Below are the most common reasons this can happen, listed in order of how often we see them.
This is the most common reason a plan cannot be linked.
Even small differences can prevent an insurance plan from finding your coverage, such as:
If any of this information does not exactly match your insurance records, the plan may not return a result.
Sometimes a plan responds, but does not provide enough information to calculate your benefits.
For example, the plan may leave out:
When this happens, Thrizer cannot safely estimate your out-of-pocket costs without additional verification.
Some insurance plans are unable to return eligibility and benefit details in real time.
In these cases, the plan may:
This is a limitation of the insurance plan, not your coverage.
Some insurance plans require benefits to be verified by phone, especially for out-of-network mental health services.
When this is required, an instant online check is not possible.
If you recently:
Your plan information may not yet be available across all insurance systems.
Some plans manage mental health benefits through a separate administrator.
In these cases, the plan may return medical coverage information but not behavioral health benefits in the same response.
A small number of plans allow out-of-network claims but do not make out-of-network benefit details available through online systems.
When this happens, automated benefit checks are limited.
If Thrizer cannot link to your plan automatically, this does not stop you from using Thrizer.
Thrizer may need to verify your benefits manually or confirm details directly with your insurance plan before providing an estimate.
Insurance benefit checks are based on information provided by your health plan. Final reimbursement amounts are always determined by the insurance carrier after claims are processed.
