Thrizer for Out-Of-Network Benefits

Accessing most types of specialty healthcare right now is difficult. A lot of small private practices are full and/or not participating with health insurance. Patients are then faced with the choice of whether or not treatment is worth cash pay or, worse, they may not have that choice because the cost is completely out of reach.

Fortunately, Dr. Dug is set up with many of the major healthcare plans in Hawaii, North Carolina, and Washington state. However, she has made the intentional choice to not contract with certain health insurance companies whose reimbursement rates for mental health treatment are less than half of the rates of other companies and/or have burdensome paperwork obligations.

Dr. Dug does want to help increase access for patients who have one of the health insurance plans that she does not contract with.

The Beauty of Thrizer

Many of our health insurance plans do cover mental health treatment with clinicians who are OON; however, these companies make it hard for us to actually use those benefits.

First of all, we often cannot tell what our OON benefits actually are, which means we have to call them (and potentially be on hold for a very long time) or send an email and wait days/weeks for a response. Even when we are able to reach the health insurance company, we may not be asking the right questions and thus, do not receive the information we seek. Even when we are successful through all of that, we are then faced with the next step of filing for a reimbursement, which requires snail-mailing paperwork from the clinician as well as the health insurance company’s form. In the end, most of us will just forego using our OON benefits because it just seems too burdensome.

Companies like Thrizer facilitate the use of OON benefits. When you sign up on Thrizer, you will input your health insurance information and it will tell you exactly what your benefits are and your financial responsibility (like a copay) for psychology appointments. You pay Thrizer the amount you are responsible for plus Thrizer’s fee.

Thrizer takes care of everything else.

Thrizer pursues reimbursement from the health insurance company and even if they run into a problem and are unable to get paid, they do not “claw back” money from the patient.

Why should I pay a fee?

As a patient, it’s a no-brainer to use Thrizer even though you have to pay a fee. Look at this example (fees show in the example are fictional and chosen for simplicity of math; they are not based on actual fee amounts):

I go see Dr. Shrink for an appointment and pay the $10 fee. I do not use OON benefits and am just out the $10.

Or… I go see Dr. Shrink for an appointment. I pay Thrizer my OON responsibility of $3 plus Thrizer’s fee of $2.

A five dollar outlay seems a lot better than a $10 outlay – for the same amount of effort.

This webpage gives more information about how Thrizer works.