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The world of therapy is rapidly evolving. Demand for mental health services has doubled since the pandemic, and the stigma around therapy is slowly but surely decreasing. At the same time, therapists are making the shift to go out-of-network because they want to maintain autonomy, earn the rates they deserve, and are done dealing with insurance.
Both of these trends are great news - clients are seeking therapy and therapists are seeking balance. The bridge between the two to keep therapy accessible is out-of-network benefits. These benefits allow therapists to set the rates they want while enabling clients to get reimbursed 50% or more of the session cost depending on their insurance plan.
Navigating the world of out-of-network benefits can be challenging for therapists and clients. That’s where companies such as Thrizer, Reimbursify, Mentaya, and Advekit can be helpful. These companies take the burden off of clients and therapists and manage the insurance hassles on their behalf. They verify your clients’ out-of-network benefits upfront and serve as a guide through the reimbursement maze. Some of them even help clients skip the reimbursement wait, helping clients more easily afford therapy upfront. The ultimate goal is to ensure clients maximize savings and don’t leave any money on the table that they can leverage. These services can in turn help therapists improve their client experience and attract more private pay clients who may otherwise be wary about starting therapy due to the cost.
You might be thinking - why can't I do this myself? I can offer superbills to clients. While that is true and superbills are great, here is the reality:
So, how do you choose from these options? In this article, we provide you with a comprehensive framework that you can use to evaluate the right service for you. We have narrowed in on this set of factors based on the most commonly asked questions we receive from therapists. Furthermore, we explore how each service performs against these factors.
Upfront affordability: Would you like to help your clients afford therapy upfront and skip the reimbursement wait?
Protection against claim denials: What happens if your client’s claim is denied? Does the service offer protection against claim denials?
Favorable therapist pricing: How much are you paying as a therapist for the service? Are there monthly fees or contracts?
Favorable client pricing: How much is the client paying per claim? Do clients pay a fee if they are working towards a deductible?
End-to-end claim management support: Is the service solely submitting the claim or managing it end-to-end for clients?
Instant benefits calculator: Would you like an instant benefits calculator to verify your prospects out-of-network benefits in real-time?
Below, you can see how each company addresses these important factors. All of this information has been sourced directly from the companies' websites to provide you with a source of truth.
We will explore each of the factors above in more detail across these options.
In the typical out-of-network process, clients submit a superbill and wait weeks for reimbursement. Thrizer and Advekit offer clients the option to just pay their co-insurance portion for sessions, while they float the rest of the therapist’s fee and wait for reimbursement on the client’s behalf. This service can be incredibly helpful to clients, as it helps them skip the reimbursement wait and more easily afford therapy upfront. Mentaya and Reimbursify do not offer this service. Clients would need to pay the therapist’s full rate upfront and wait weeks for reimbursement via a check in the mail.
As with in-network, out-of-network claims may also be denied by insurance for a variety of factors (often unknown and a complete black box). Therefore, it is important to understand whether the company offers protection for both clients and therapists against claim denials.
Thrizer offers this protection. Since Thrizer takes on the risk of waiting for reimbursements on the client’s behalf, it’s on Thrizer if a claim is denied. They have a strict no back charges policy for clients and therapists, even in the case of claim denials. Advekit does not offer this protection, so clients may be back charged for claims they do not receive reimbursement for after fronting the session. Mentaya and Reimbursify also do not offer protection. If a claim is denied, clients are responsible for the full session cost without any reimbursement to help them. Mentaya only offers a refund of the claim submission fee.
Therapists typically have the following fees associated with out-of-network billing services: 1) a standard credit card transaction fee per session (in all scenarios), 2) a monthly fee for the benefits calculator (if applicable), 3) a monthly membership fee (if applicable), and 4) additional per session transaction fees (if applicable).
Let’s break down the fees for therapists by company:
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Clients typically pay a fee per claim for these services. It is important to understand the benefit that clients are receiving for the fees they are paying. Clients may be working towards a deductible or have already met their deductible - and it is important to understand what the “claim submission fee” applies towards.
Let’s break down the fees for clients by company:
Thrizer, Advekit, and Mentaya deal with all of the insurance back-and-forth - e.g. resubmissions, additional verifications, claim denials - allowing clients and therapists to solely focus on care. Reimbursify only submits claims. Clients have to get on calls with insurance to manage any additional back-and-forth. This could mean hours lost every month dealing with these hassles.
Instant benefits calculators can be extremely helpful to quickly verify clients’ out-of-network benefits, especially while on prospect calls to provide them with upfront transparency on your session cost. Thrizer (free), Reimbursify ($59-99/month), and Mentaya ($29/month) offer these calculators, whereas Advekit does not.
In summary, we understand that out-of-network benefits can feel like a black box similar to all other insurance processes. These services can help you navigate the maze and make your clients’ lives easier, so you can both focus on what truly matters. They can also be very helpful in attracting and retaining private pay clients. So what’s the verdict?
If you are looking for a comprehensive, reliable, and affordable partner for your out-of-network needs, Thrizer is the clear winner.
Thrizer’s mission is simple: help clients pay less and therapists earn more - while keeping fees low and quality high. They are built by long-time therapy goers who have the utmost appreciation for therapists and have lived the challenges that come with affording therapy consistently. They have taken the time to listen to both therapists and clients to understand the major pain points of out-of-network therapy and intentionally craft an offering that is simple, affordable, and transparent.
Thrizer’s reliable customer service, strong billing expertise, client and therapist pricing, and upfront affordability sets them apart. Here are the key factors we discussed above:
Yes, Thrizer and Reimbursify offer client-only options if therapists prefer to be minimally involved in out-of-network billing. With this option, therapists just have to provide superbills to their clients.
Thrizer offers a superbill upload service that therapists can direct their clients to or link on their websites or client portals instead. Clients can upload their superbills for $2/claim. Thrizer submits and manages the claim end-to-end, and deals with any insurance back-and-forth for the client. Clients receive reimbursements via direct deposit after a few weeks.
Reimbursify also offers superbill uploads. Clients pay $3.99/claim. A key difference is that they only submit the claim, and it is on the client to deal with any insurance back-and-forth. Clients receive reimbursements via a check in the mail after a few weeks.
Advekit and Mentaya do not offer a client-only service - that is, therapists have to use these services themselves in order to offer their perks to clients.
We hope this article gave you a more comprehensive view into the various out-of-network billing options available to you. You now have a robust framework to evaluate these options and ask the right questions. There is so much to be excited about within therapy today: more clients are seeking therapy, and therapists are breaking out of the leashes of insurance and charting their own path. We are here to cheer everyone on.
If you would like a more comprehensive comparison across these services, you can visit the below resources:
Feel free to check out these other related blogs that might interest you:
If you would like to learn more about Thrizer, visit our website and get started in minutes! You can also view our demo or request a call.
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This blog post is provided for informational purposes only and is not intended as legal, business, medical, or insurance advice. Laws relating to health insurance and coverage are complex, and their application can vary widely depending on individual circumstances and state laws. Similarly, decisions regarding mental health care should be made with the guidance of qualified health care providers. We strongly recommend consulting with a qualified attorney or legal advisor, insurance representative, and/or medical professional to discuss your specific situation and how the laws apply to you or your situation.
