Say Goodbye to Superbills • An Interview With Sanjana Sathya

Transcript is generated by computers – sorry for any confusing words it misunderstood.

Greg:
Hello, everybody out there, private pay therapists, psychologists, psychiatrists, mental health professionals. I’m here today to talk about how you can take full pay clients who need insurance when you don’t take insurance. How often does it happen? You’re on a consult call, you’re on an intake call with somebody, you got a great rapport going, they know you don’t take insurance, but yet maybe they still came to the call secretly hoping you could work something out. A lot of times, historically, right, those calls end with, I’m so sorry, I can’t give service to you. I’d love to help you, we’re a great fit. It’s just, you know, it just doesn’t work. But what’s really exciting is there are actually ways out there that you can get paid your full pay private pay rate while still allowing your clients to use their insurance.

I’m here today with Sanjana Satya who is the co-founder of Thrizer which is a company right here in the San Francisco Bay area that helps you do exactly that. So I’m gonna actually, you know, I’m really excited to have you here. We’ve talked a lot over the past months and I’ve gotten to know your platform and you and you’re a super awesome person. I’m grateful that you’re here and that you’ve created this product for therapists. And, you know, I’d like to learn a little bit more about you, about Thrizer, about how your platform works.

But before we jump into that, you know, I would really love to just know if you can share a little bit more about the general concept of out-of-network benefits. Because I know in my work as a therapist marketing coach, a lot of the therapists that I work with don’t even realize that this is an option. Which is why it’s so exciting that you’re here because you could probably explain it a lot better than I can.

Sanjana:
No, thank you so much for having me. Yeah, absolutely. So out-of-network benefits can feel nebulous, confusing, especially if you’ve been accepting insurance and you want to transition into private pay. Either you haven’t heard of them or you’ve heard of them and you don’t know how to help your clients navigate through them. So that’s really where Thrizer’s mission comes in to kind of simplify the whole process. But I’m happy to share a little bit more about what they are, how they could be your best friend, both as a clinician and a client. So in a nutshell, right, out-of-network benefits are benefits that exist in a client’s insurance plan that can still get them reimbursed, you know, on average, what we’ve seen 70% of the therapy costs, even if you don’t directly accept insurance. So, you know, they exist in a lot of different plans, you know, especially PPO plans, a lot of non-PPO plans also have it. And what is really neat about it is that you, as a clinician, can charge your full private pay rate, but then the client can get back 50 to 70 percent, sometimes even more of that session cost so that it’s not just on you to accept insurance to be accessible to them. They have other financial means to pay for therapy sessions. And so that’s why I love out-of-network benefits. I use them myself. I’m a long-time therapy goer. And when I found out I had out-of-network benefits, I started getting reimbursed up to 60, 70%. And it was the best feeling because I was able to continue sessions weekly with my out-of-network provider who I had found a great fit with.

Greg:
That’s awesome. Yeah. I say it sounds like it’s almost getting the same amount, if not more than you would get from the insurance panel if the therapist were still on insurance. That’s great. And then I’d love to just hear a little bit about obviously, you know, you’re co-founder of this company, you know, how, what is, what is Thrizer? And if we will Tell me a little bit about the background, how this company came to be, whatever you’d like to share about that. I love stories. I love superhero knowledge and stories.

Sanjana:
No, absolutely. So Thrizer was founded by 2 longtime therapy goers. That’s really our inception story. We both found our fit without our network providers, had to be seeing our therapist weekly and wanted to see our therapist as frequently as we could, but super bills became very difficult to navigate, right? A lot of times, I would submit super bills and never hear back. I wouldn’t even know where to submit it. It would kind of go into Neverland, and I wouldn’t even get a confirmation email that I sent to the right place. And a lot of times then, OK, I had to get on insurance calls. And the last thing I wanna do is get on insurance calls. Like it’s just not something that clients want to do and therapists don’t wanna do it either. And so we really saw this as a need in the space of what if we just let therapists focus on care, clients focus on care, and there is this other entity or stakeholder that takes care of all the insurance stuff. And that’s really where Thrizer was born because we were able to kind of automate a lot of things, integrate with medical clearinghouses and just make the whole process so much more efficient so that you don’t have to deal with insurance. And, you know, I, as we said, we really would have hoped that Thrizer was there when we needed it. And so we kind of built it for ourselves and it ended up being something that a lot of people really resonated with. And it ultimately ended up making therapy much more transparent, right? Because you get the price transparency upfront, you get accessibility. We have a cool thing where clients can actually just pay a co-insurance, even though the client or the therapist gets their full rate upfront, right?

Greg:
Which I’m happy to talk about more later. And three is no more super bills, like no more needing to navigate insurance automatically gets submitted to insurance. And we handle claims end to end. So there’s really no need for the clinician to get involved.

Sanjana:
Yeah, that’s great. And that’s 1 of the things too that speaks to me so much is in so many conversations I have with therapists and especially from a marketing and a website and optimizing your intake process and all of that. It’s like trying to even explain the concept of a super bill to someone. I’ve been working with therapists for 18 years. I still don’t fully understand the concept of a super bill. It’s confusing and dealing with so many people I work with spend hours a week on calls, the therapists with insurance carriers, trying to sort through the things that you do for them. So it’s like getting people back their time, which is Really nice. And just as a client, making it easier to just start that relationship because the last thing you want to worry about is how to file weird, confusing claims to hopefully maybe get some of your money back. So thank you. And thank you for creating this. And I thought it’d be fun if we did sort of like a mock intake call, because I would love to personally, I don’t know anyone watching this, if you’re with me, I would like to see this in action. What does it actually look like out of the, you know, yeah, so with Ropework, we can do a mock intake call where you pretend to be the therapist and I’m the client and, you know, we’ve had a nice little conversation. Oh my gosh, This is going to be the best therapy ever. I’m really excited to get started, but I did want to talk to you real fast about my insurance.

Sanjana:
Yeah. Yeah. So, I am actually out of network, which means that I don’t accept insurance. My private pay rate is $200 a session.

Greg:
Okay, I don’t really think I can pay that, like maybe for 1 session, but if any kind of long-term relationship, it’s just, it’s not gonna work. Do you do sliding scale or anything like that?

Sanjana:
Yeah, but I actually also have another avenue that we can take a look at. So in your insurance plan, you might have these things called out-of-network benefits, which basically means that even If I don’t accept insurance, insurance will still reimburse you a large portion of our therapy cost. So if you want, I can actually quickly check your benefits using Thrizer, which is the platform that I use for out of network billing. If You can just provide me your information. I can quickly check if you have these out of network benefits.

Greg:
Yeah, sure. So would you just literally need me to tell you what my insurance number or who my plan is? What do you need from me to make this happen?

Sanjana:
So here we go. So Here’s basically what I need from you. My private pay rate, like I said, is $200. I would be seeing you for individual psychotherapy. Really, all I need from you is your name, your first name, last name, date of birth, insurance company, and your member ID. So hopefully, if you have all that in your name.

Greg:
Okay. Well, here, let me go ahead and get my card out. My name is Gregory Goodman. It’s 12345678910. And I believe that’s all the information that you need.

Sanjana:
Yeah, pretty much. Just so that we don’t actually run it and I want to you know violate PHI here, but I actually have Something pulled up here. So you’ll see this is basically what I can Get let you know so assume this is Gregory Goodman, right?

Greg:
My name is Jasper Taylor here and I guess this is my plan information.

Sanjana:
Yeah, exactly.

Greg:
I forgot my name. I went off script and I forgot the name I was supposed to use.

Sanjana:
No, you’re totally

good. So yeah, here’s your basically your out of network benefits. So exciting news is you do have out of network benefits. What this means is that you have a deductible, which is essentially an amount that you would have to meet before you are eligible for reimbursements from insurance. So that would basically be $2,000. You would meet that in 10 sessions, right? So about 10 sessions, you would be able to start being eligible for reimbursement. And so the cool thing, though, is that you’ve apparently already met your deductible. So the amount remaining on deductible tells you, OK, like how much is remaining on your deductible. You’ve actually met the 2000. If you had had it met it, you would have met it in 10 sessions. But you’ve met it here. So the really cool thing is you’re actually already eligible for reimbursement from insurance. The estimated reimbursement amount that we’re predicting for you is $120. So, you know, that means that you no longer have to pay 200 for my sessions, you would actually only pay $80 for these sessions, right? Because you will get back $120 from insurance for our sessions. So that’s really awesome. Hopefully $80 is much more manageable for you than the $200.

Greg:
Yeah, absolutely. I’m curious, This is, I don’t know how to work this into my pretend Jasper personality, but the amount remaining on deductible just as a general curiosity, is that for, and maybe it’s different for different insurance carriers, is that for all services or is that specifically a psychotherapy mental health deductible that’s different than my out of network, out of pocket deductible for medical or specialist visits or anything like that?

Sanjana:
Yeah, yeah. So there will be different buckets that these services fall into. So you’ll have separate deductibles for the bucket that it falls into. So this might actually also cover physical therapy, occupational therapy, some of the other therapy services. So this might be, you know, this will be like your therapy deductible, right? And so this is specifically your out of network therapy allowance, which is or deductible, which is a 2000. But in this case, you’ve already met it.

Greg:
Okay. I’m gonna pretend for a moment that my amount remaining on deductible is still a full 2000. So, okay, so this all sounds great, but what I’m understanding is For the first 10 sessions, I’m going to pay $200, your full rate per session. And then after that, I’m going to be paying $80 per session. But am I always paying $200 to you and then the insurance company is gonna give me my money back? How long does it take for my insurance company to give me my money back? Who’s paying, who’s giving me that 120 bucks back?

Sanjana:
Yeah, yeah, so really good questions. The 1 nuance here to note is that the amount that gets applied towards the deductible is the allowed amount. So it won’t necessarily be the full 200. That’s why I said it’s approximately 10 sessions. The reason being is that, and we can go over this in more detail. We’ll have a full, how does the math work for all of this section. But insurance basically sets an allowed amount. What that means is that they will say, you know, and you can see here, we’ve estimated that for this particular insurance plan, the allowed amount is 150. And it also says your co-insurance is 20%. So what that means is that insurance is only willing to reimburse 80% of that allowed amount for this particular insurance plan. And hence, that’s where that 120 comes from, right? And so only 120 gets applied towards the deductible each time even if the client or you know, you would have to pay 200 120 120 120 would need to then add up to 2000. So whatever, you know, 2000 divided by 120 is that’s how many solutions you would end up paying the clinicians full.

Greg:
Got it. Okay. So, so in this, so okay, so in this 2000, a relatively standard doctor, I mean, I know it probably depends on if they have the gold, the platinum, the silver, the bronze plan or whatever that is, but is that sort of an industry average that we’re looking up there, the 2000 for deductible?

Sanjana:
Yeah, unless we’re talking about high deductible plans, which of course exists and you’ll see upwards of $10,000 and stuff like that. Typical plans are between $1,000 to $3,000 as the deductible amount. So sometimes you’ll even see plans that are $750, $1,500. So I think that is probably the right range to think about.

Greg:
And then, so when the refund comes, the reimbursement, for $120, once the deductible is met, is that coming from the insurance plan, or is that coming from you, from Thrizer?

Sanjana:
Yeah, so Thrizer is actually making the whole thing really simple for clients. The way it normally works, right, this is how it would normally work if I as a clinician were to provide you with a super bill, right? So the normal process is I provide you with a super bill. I say you’ve come to me for, let’s say you’ve already met your deductible, right? You’ve come to me for a session. I charged you $200 for that session. You submit that super bill to insurance. And then you have to wait 4 to 6 weeks for a check in the mail for that 120.

Greg:
Actual old-fashioned paper checks coming.

Sanjana:
Yeah, it’s old-fashioned paper checks. Insurance has not caught up at all.

Greg:
Sorry, please continue.

Sanjana:
Yeah, literally, right? I mean, that’s already very nerve-wracking. Like, I mean, even when I was waiting for checks, like, I was like, Okay, what if I have the wrong address on my insurance? What if it gets lost, then I have to go through the whole process of calling my insurance. Will they even believe me that I never received it? It’s just a lot of stress with paper checks. Every step of the way, insurance just finds a way to make things really difficult. And so yeah, I mean, that’s the typical process. Thrizer recognizes that there are so many friction points at every step of the way. First of all, me needing to even request a super bill for my clinician, right? Then me needing to figure out where to submit it. And then I have to call insurance to follow up. Did you receive it? Can I accept this? Also, I have no idea how much in reimbursement I might expect, right? There isn’t that price transfer. And so they’re not gonna send you an email saying, oh, we’ve received your claim. You’re estimated to receive 120, right? There’s no communication whatsoever. But what Thrizer is aiming to do is you have this you check benefits upfront, so you’ll know exactly like we estimate you get around $120. And then from there, if you’ve met your deductible, you can actually just pay your coinsurance for sessions. And that’s kind of what I was alluding to earlier. So I as a client or I guess you as a client here, you would only pay $80. Yeah, you would only pay $80 at the time of the session. Thrizer would cover the rest of the $120 for me. So I’m still getting paid $200 at the end of the week. And then Thrizer waits for 120 from insurance to pay them back.

Greg:
Okay, so that’s cool. So once me, Jasper, meet my deductible, I am not like I’m paying $200 every session and then waiting for Thrizer to give me back. I’m now paying by $80, the difference between the reimbursement amount and the clinician’s rate.

Sanjana:
Correct. Yeah.

Greg:
Great. Okay. That’s really convenient for the, for the client. Yeah. And you, is there anything else that you wanted to show on this because I’ll get it back to just The 2 of us on the screen unless there’s anything else in this window that you think is worth sharing.

Sanjana:
Yeah, one thing I’ll note is that the estimate before we submit the first claim, the way that we’re able to estimate this amount is based on an estimated allowed amount, right? So this number right here, the deductible comes directly from that client’s insurance plan, amount remaining comes directly from the plan and coinsurance comes directly from the plan. The only one that we’re kind of guesstimating is this allowed amount. And Thrizer has a bunch of just wealth of knowledge because we submit so many claims across many different insurance plans that we’re able to say, hey, based on this insurance plan, we estimate that the allowed amount is 150. So that, you know, it is an estimate. So once we get back the first claim, we’ll know in actuality how much that allowed amount is. Like insurance is notorious, they’re not going to share that. I’ve had a time with us And it does actually vary by client. So we make it very clear even when the client receives their estimate, we ask, you know, clinicians make it clear, hey, here’s an estimate. But once we submit the first claim and get it back, we’ll know in actuality what that estimated reimbursement amount is, and that won’t change moving forward.

Greg:
Got it. OK. That makes total sense. So shall I remove the screen? Was there was there something else that you did? Look at that.

Sanjana:
No, that’s it on that screen.

Greg:
Yeah, it’s I, of course, see this because I work with a lot of mental health professionals who are private pay, higher, higher session rates. And it is, you know, it’s, you know, we were joking about

it earlier that just there, no matter how many times I say on a form, on a contact form, like I do not take insurance. People just, people still book that free consult. They still reach out. And whether it’s just blindness to it or just like secretly hoping, like maybe you’ll make an exception for me because insert reason here. I find that so many therapists do wind up, so many private pay, exclusively private pay therapists wind up on phone calls with people who are hoping to still have that insurance kick in.

Sanjana:
Yeah, yeah. It is, I know from a client’s perspective, it’s probably wishful thinking, or to your point. And we actually recommend people, therapists who do use Thrizer, can put on their psychology today, can put on their website that says, hey, I’m out of network, but you might have out of network benefits, I can help you verify it for you, right? So there might be a client who’s like, oh shoot, they don’t take my insurance, but oh, hey, what is this out of network benefits? I’m curious, I’m really like this therapist, I wanna get on a free consult call with them. Maybe I do have out of network benefits. And it’s very easy for a clinician to check that using Thrizer’s platform.

Greg:
Right. And it’s interesting, too, because there’s still that deductible, which is just the way the industry works. No comment. But it still requires a financial investment by the client, right? It’s not like, oh, we’ve got Thrizer and from day 1 I’m paying 80 bucks a session, right? There’s still, it’s, you know, it sounds like that this is an amazing solution and there’s still this, you know, industry that you’re existing in that has these requirements and there’s just no way around it, but it’s still a million times better than like, you’re just gonna have to pay 200 bucks for, you know, for the next insert, you know, ongoing therapy session forever.

Sanjana:
Yeah, yeah. No, I honestly like that is the one thing if I could wave my magic wand and say, hey, come on, let’s actually fix something. I mean, there’s so many things I wanna fix, but it would really be, let’s lower the deductibles, right? To your point, it is really disheartening when I see a client who has a $5,000 deductible or a $10,000 deductible, because on paper they have out-of-network benefits, but they actually don’t, right? They can’t ever access it, especially because deductibles reset every year. And so yeah, it’s unfortunately just the system we exist within, I’m hoping in the future, Thrizer, we can come up with really unique solutions to help people meet their deductible too. It’s definitely on our roadmap and radar. But it’s the industry we live in.

Greg:
Yeah, 100%. Of course, you think about like, I just think about all the other countries out there and all the other stories I hear from international clients and people just of how different the mental health world is outside of our 48 continental and 2 slightly off the continent states. Anyway, that’s a whole other conversation that we can probably talk about. Is there anything else that you’d like, you know, that, what would be the most helpful, like aside from how Thrizer works with things like, you know, specifically about the product, like I really just, is there anything else that you can think of that anyone watching this, and it doesn’t have to be, you know, should know that would be helpful to know about the world of insurance, about the world of reimbursement, things just, I get the idea from our conversation and just from the therapists I work with that some people are like, yeah, yeah, yeah, I know all this. And if you know all this, you’re probably not still watching this video right now. But for people who are newer to the world of maybe transitioning from insurance to private pay or just don’t have this background, what other things should people be thinking about or should people know when it comes to this world?

Sanjana:
Yeah, yeah. I think that for someone who might be completely new to all of this, maybe that intake call was even a little too nuanced, right? Maybe people are still trying to figure out, hey, what is an allowed amount, right? What is a co-insurance? What are those, what are those terms mean? So I’m happy to, I have a deck here. It’s typically what I share with people who are new to the space. They just need something a little bit more visual and walk through of here’s how out of network reimbursements actually works. If we just take a step back. So I’m happy to walk through that if you feel like some people might be needed that space.

Greg:
You know, my instinct is like, let’s do that. If anybody’s like, hey, I watched this. It’s cool. I’m just ready to reach out. Just you can reach out directly. I’m going to put contact information if you’re reading this on my blog or on Facebook or on LinkedIn or whatever it is like below this video somewhere There’s some reach out contact information so you can learn more schedule a demo You know see if Thrizer is a fit for you and with that little call to action out of the way. Like, yeah, I would love to learn more.

Sanjana:
Yeah, absolutely. So let me actually share my screen again. Let me know if you can see this.

Greg:
You get it up and running, and I’ll click the little button to get it going.

Sanjana:
OK, Here we go. So do you see that?

Greg:
No, I do. Are you? Want to put in the slideshow and there we go.

Sanjana:
Cool. Awesome. Feel free to Button and ask as many questions putting on your I’m new to private pay hat. You know because I read this every day So I might go a little too fast.

Greg:
We’ll see what Jasper wants to know.

Sanjana:
Yeah, right. Cool. So how do out-of-network benefits reimbursements work? So again, like I said, I think it’s important that every private-paid therapist understands this because it really is thousands of dollars per year that a client can save, right? Even if a client, it doesn’t outrightly express that the $200 or whatever the rate is expensive for them. I know when I started therapy, I eventually have to stop because maybe month 5, right? I was like, I’ve invested too much in this. I don’t have the cash flow for it, or I don’t have the money for it. Versus if I’d been getting reimbursements along the way, I would have continued therapy. I think it’s just so much money that has the client’s name written on it that we should make sure that everyone’s educated about this. That’s my big soapbox that I like to share and what Thrizer’s mission really is. So with that, we’ll jump into it.

Greg:
Great question. As you’re talking about this, right, let’s, me Jasper, I’m like, yeah great, I could probably just pay my $200 forever. I got a really great job. I make tons of money. But I’m curious, would it make sense for me to still use Thrizer with my out-of-network insurance because who wouldn’t want an extra $120 per session in their pocket because my understanding is that if I’m paying you private pay and we’re not going through Thrizer, it is not coming out of my deductible, right?

Sanjana:
Yeah, it’s not. It’s not. You have to still submit your super bills, right? You still have to go through all of that. So the really cool thing, and we can go into more detail on how Thrizer works from a nuts-and-bolts perspective, you know, at heart, we’re a payment platform. So as a clinician, if you charge your private pay client through Thrizer’s payment platform, we automatically submit claims for them every time you charge them. Right. So there’s no need for Jasper to request super bills, submit it. Right. It just happens as soon as he goes to therapy, there’s really not much further that Jasper has to do. He just needs to show up to therapy and then go home. And he’s only paying $80 a session instead of 200. Why would he not do that? I think a lot of clients are scared away by the fact that, okay, I might get back $120, but then I have to like submit my super bill, college insurance, and you know, it’s all this and like for something that’s not certain why do I have to invest all that time and I can just pay $200, right? And there’s so many people that I know like that. But if it’s like just integrated within their workflow, right? It’s easy for the clinician. It’s easy for the client. Like let’s give him back 120 so he could go to more therapy or he could go like every like twice a week, right? If he needs it. Right. Or something like that.

Greg:
Yeah. The more the, the, my marketing hat and bells and whistles are just like, what a great selling point, right? What it is, on an intake call, what a great added benefit of going with me or someone else. It’s like, yes, I’m a private pay therapist and I charge $3.50 an hour. And yes, you can afford it. But if you’re concerned about the long-term sustainability of that, I actually work and I have a way of blah, blah, blah, everything we were just saying. That’s for these high ticket, high session rate therapists, a lot of whom are people that I work with are folks who are charging $250, $300, $350. It’s a tough sell. And every little thing helps to ease the financial burden of the dream client

. And it’s, you know, we’re not trying to say like, okay, this is part of my initial, you know, what I’m saying, like, hey, we get to the point we’re talking about money. It’s like, just so you know, this is a possibility. I don’t know, I just, I feel like I just came up with ideas. It’s like a half-baked idea, but it seems like a good marketing thing to explore.

Sanjana:
It really is. Yeah, it really is. Like I think if you think about what we’re trying to do at Thrizer, it is bringing the best of in-network therapy and out-of-network therapy together, right? Clients like in-network because they just want to pay a copay. Clinicians like out-of-network because they want to charge their full rate and not have to deal with insurance, right? And if you think about it, it kind of may seem too good to be true, but we truly believe this is what the future of therapy should look like. It is everyone being treated the way that they should, and paying the least amount from a client perspective, but receiving the most and what they deserve from a clinician perspective. And if we’re not able to make insurance get there, then we’re gonna have to use things like Thrizer to make sure that we create a system that’s more equitable.

Greg:
Love it. Please continue with the-

Sanjana:
Yeah, cool. So just really quickly, what we’ll cover is high level again, how is insurance different for out-of-network versus in-network therapy? How do we calculate an out-of-pocket cost for a client? What is the reimbursement amount that they receive from insurance based off of, so there are things that we covered on that benefit verification page, but a lot amount deductible co-insurance, and then a quick example and some resources. So again, as we covered, in-network means insurance sets the rate and clinicians can charge, right? And then a client pays a copay, clinicians wait for reimbursement from insurance. Out-of-network, clinicians will set their own rate, give them the financial freedom that they want, but then the clients on the hook to submit their own super bill and wait for reimbursement in the typical world, right? And so that’s just a high level how in network and out of network is different for someone who might be completely new to this space. And then if we kind of go into just step-by-step, how is a client’s out-of-pocket cost calculated in out-of-network therapy? It is basically the clinician rate minus whatever the insurance company is reimbursing the client for that session. So, in the Jasper example, what we had was the clinician rate was $200 And insurance said, hey, I’m going to cover 120 of it. So then the client cost was $80. So that’s basically how the math works at a high level for what is the client cost. And we have a different example here. So if it’s 200 and then the reimbursement is 150, the client’s out of pocket cost is $50. Any questions here so far? Keep going.

Greg:
Keep going. I may sneeze, so I put it on.

Sanjana:
Sounds good. Cool. Yeah. So the TLDR here is that the client is responsible for the difference between clinician’s rate and then the reimbursement they receive. Yeah. So we get this question a lot. You know, how is out and how, what is that out and network reimbursement amount then? How do we actually figure it out? And so it varies by individual plans. So oftentimes we’ll see very similar plans, but they could have slightly different or completely different reimbursement amounts. And that’s again, because it’s a complete black box. We don’t know exactly what goes into it. There are different things like a clinician’s licensure, geography, virtual versus in person, like there’s so many things that go into it and it’s really hard to parse it out, but it does vary by individual plans. But there are a few things that are kind of common across in terms of how you can read the benefits that you receive. And those things are a deductible allowed amount and a coinsurance percentage, which we’ll go into a little bit more detail on the future slides. Cool. So deductible. So we talked about it in that example already. Basically, it’s the amount that a client has to meet before starting to receive insurance reimbursements. We talked about how typically it’s between the 1000 and 3000 range, unless a client has a high deductible plan. And the client will have to pay the therapist full rate for the sessions until they meet that deductible, and only the allowed amount gets applied towards that deductible. So that’s what we talked about in the earlier example. Basically, that 120 is what gets applied towards the deductible, not the full $200 because that’s just the limit that insurance is setting for that particular insurance. A loud amount. So this is the black box. So this is basically just insurance saying, hey, we think that, you know, it’s kind of like in-network, how they say a clinician should only get paid $80 or $90 or whatever, right? It’s kind of like-

Greg:
How do they come up with these things? It’s so Who are the number correctors? Like, the value of this therapist is in the moment.

Sanjana:
Right, exactly. Who are they anyway?

Greg:
Exactly, right. It makes no sense, but unfortunately, that also comes into play for out-of-network benefits, but they set some limit of it, right? They’ll say 150 or 120 or whatever it is, but the client might actually be responsible for a portion of that allowed amount. So when you see in that example, we saw that, OK, the allowed amount was 150, right? But the client might be in charge of 20% of that 150, which actually means then that the insurance company is only reimbursing 80% of the 150. So it’s not even like the actual allowed amount. It’s just everyone’s responsibilities combined is 150, right? And that’s the allowed amount that they set. So again, complete black box. This is just data that we’ve gathered at Thrizer and happy to share it is just across different insurance plans, the average allowed amount that we’ve seen is 130. So again, you know, the client might be responsible for 10%, 20%, 30% of that just depending on their plan. But that’s what insurance has set as, you know, how much a therapy session is worth, basically. Cool. Shocking. Yeah, I know. And then the coinsurance percentage, again, is just how much of the allowed amount is the client responsible for. So it could be 20%, 30%, whatever it might be. And the percentage comes off of that allowed amount, not the clinician’s rate. So this is where it can get a little confusing. And we’ll run through an actual full example coming up soon, but a lot of times people will not realize that there’s this concept of an allowed amount. And so they’ll call their insurance and they’ll say, Hey, like, you know, the only two numbers they’ll get is your deductible is $2,000 and your co insurance is 20%. Right? They’ll get that from their insurance call and then they’ll come back home and they’ll try to do their own math and say, okay, so my therapist charges me $200. That means that I only have to pay 20% of 200, right? That’s not how the math works at all, which is just the most confusing thing in the world. It basically means that you have to pay that percentage of the allowed amount, and then you have to pay the difference, right? So we’ll run through the math, but it’s important to kind of know how the calculations work.

Greg:
But I’m just curious from my own understanding, in-network insurance, right? You’re just paying the, do you still have to pay the deductible with in-network insurance?

Sanjana:
Yeah, typically there is a deductible in network as well. What we’ve heard and seen is that the deductible might be slightly lower than the out of network deductible.

Greg:
So, but if I’m going to you, right, and you’re an in-network therapist and you accept my insurance and your rate is $200, I still, before I get reimbursed by my insurance company, I still have to meet some kind of deductible.

Sanjana:
Correct.

Greg:
Yeah. It’s not like This whole dream of like, oh, insurance clients are so much easier. There’s still a lot of the same financial burden on the client.

Sanjana:
Yeah, exactly. Exactly. Yeah, I was going to say when I was new to the space, I was also kind of learning about all of this and I also did not recognize that in-network also has a deductible. You’re absolutely right. In-network will still have a deductible And that still needs to be met even if you’re then paying a copay of $40 per session.

Greg:
Sure. So I’m still just, I’m still coming to you. I’m still just paying the copay, the copay. And then you’re the therapist, if I’m paying you $40, then the, as the therapist, I have to wait for the insurance company to send me the rest of the money on that paper check for the difference. But at some point after I meet my deductible, do I no longer have a copay? Do you know, maybe this isn’t even your expertise wheelhouse. I probably have a whole other somebody on here who knows, is like the insurance expert, but really the people were trying to get away from insurance. That’s the purpose of this.

Sanjana:
Yeah. Yeah. So I unfortunately don’t know, just based on my general knowledge, I do think there’s always a copay. So I don’t know. Sometimes some plans will have a maximum. So maybe after that, you are

not paying a copay anymore. But I don’t know what that threshold is. It might be like 100 sessions a year or something like that. But yeah, so typically, high level, there will be a deductible end level and there will be a copay after that.

Greg:
Sorry to give you a question there that’s not in your zone. I’m with Kaiser, right? And like I was telling you before this call, I’m with Kaiser. So Kaiser is their own way of doing everything. So it’s like their own ecosystem. So it’s a whole other world. Anyway, please continue.

Sanjana:
Yeah. Yeah. Kaiser is a whole other beast. Cool. So yeah. So then now we have all the pieces, right? Now we know what an allowed amount is and we know what coinsurance is. So then we’re able to actually calculate a reimbursement amount. So this is the amount that insurance will cover, the remaining portion of the allowed amount not covered by the client’s coinsurance. So in this example, right, if the allowed amount is 150 and the client coinsurance is 20, insurance would cover 80% of the 150, which is 120. And that’s actually exactly what we saw in Jasper’s example, right? It was based on an estimated allowed amount of 150, and he had a co-insurance of 20%. And so that means that 80% will be covered by insurance and he will be receiving 120 per session for each time that he sees his therapist. And so if we bring all of this together, right, if we know all the pieces now, right, so it’s basically, Let’s say in this example, we had a deductible of 1,500. A allowed amount is 150. Coinsurance is 20. Now we’re like, okay, clinician rates 200. How do we do the math then? The client would pay their therapist full rate of 200 for the first 10 sessions to meet their 1,500 deductible, right? Because only the 150 gets applied towards the deductible. So if we did 1,500 divided by 150, we get 10 sessions. And so then they would pay 200 for the first 10 sessions. And then after that, the client would receive 80% of the 150 allowed amount. So that’s 120 per session. So essentially, the client ends up paying $80 a session, right, the 200 minus 120. And the client saved $120 per session, right, as we did in the previous example. So that’s huge. You’re saving 60% or 70% of the cost of therapy. And that can be really remarkable for a lot of clients who are struggling.

Greg:
And clarifying questions. So this is what you’re showing here. This is just how it works. Thrizer or no Thrizer. And what Thrizer does is makes it so that neither the clinician nor the client needs to deal with the insurance company. This slide here is the lay of the land of private pay, out of network, insurance, reimbursement, super bill world.

Sanjana:
Exactly. So it’s just normally how does out of network billing work. And you know, where Thrizer can come in is that we can do all the math for you, right? And we that’s not that’s just first step. We’ll do all the math for you. We’ll let you know, as we saw in the previous example with Jasper, like deductible, allowed amount, co-insurance, reimbursement amount completely for free. So you can check it for your clients, the client can check it for themselves. And we’ll do all of that because you don’t need to call your insurance to get all those numbers. We’ll do the math for you. So all you really have to do is go to Thrizer.com and you can get started. And we kind of covered the main things that Thrizer can help with. But in this previous example, just to reiterate that, right, if the client is, their responsibility is $80, They’re paying $80 at the time of the session. Thrizer covers the rest of the $120 for the clinician and we, you know, so they’re made whole at the $200 and then we wait for that $120 back from reimbursement for 6 weeks later. So that’s how that works.

Greg:
All right. Thank you. That’s very, very educational for me. Awesome. I know that I’ve, you know, I’ve known some of this from articles and things. I haven’t seen it put together. So just step by step succinctly, like it makes, you’ve given me a lot of like ah-has. And again, too, you know, a lot of marketing ideas for how this can be utilized, especially in this hybrid of even if you’re private pay and you’re saying no insurance, like yes, my rate is $300 an hour, but after 10 sessions, you’re only going to be paying even $130 difference, it goes down to $170. And you’re still getting the exact same service from the therapist. And it’s just, right? It’s an upfront. It’s an upfront. Like most services, you’ve got the upfront investment. We’re going to get going. And then your price goes down. I can just see it as, obviously, every clinician therapist needs to come up with a way to authentically and in a heart-led space to offer that to not have it come across as pushy or salesy or any of these things. Once the right balance is struck, it seems like it would be a nice additional bonus to work with a private pay therapist, whether you’re doing it.

Sanjana:
Exactly.

Greg:
I’m very much grateful to you for your time, sharing your knowledge, and for creating this product, this service to help with improving the mental health of people who need it most and to give both the people who need the help a pathway to get the help and the clinicians, the therapists, the mental health professionals who have worked so hard and put in so many hours and so much effort and energy and student loan debts and all these other things to be able to actually charge what you as a therapist are worth. That’s what’s so amazing is everybody wins in this. You get to charge what you’re worth. You’re actually valued for the amazing service you’re providing and your dream client can get help that they so much need to make their life better. Yeah, it’s a very beautiful gift to the world you’re doing over there. So yeah.

Sanjana:
Of course. Thank you so much for having me. I think you summed it up so well. That’s basically why we’re here. And yeah, we really, really appreciate it. I’m gonna give you a promo code so that you can share it with your people. So basically they can try Thrizer for free. They’ll get waived fees for the first $2,500 in charges that they do. It’s a risk-free way that they can go in, try our free benefits calculator that they receive, test it out, see if it makes sense for their practice, and then go from there.

Greg:
Awesome. Well, thank you again for a great conversation and for so much information. And yeah, thank you to everybody who watched this video. Let us know if you have any questions. We’re both here to help and to serve and have a beautiful rest of your day.

Sanjana:
Thank you. Thanks for listening.

Greg:
Bye.