The Practice of Therapy

[00:00:00] Gordon Brewer: Well, hello everyone. And welcome again to the podcast. And I'm really happy for you to get to know Sanjana Sathya and we've practiced her name and hopefully I got it right there, Sanjana from Thryser. So as I start with everyone Sanjana tell everyone a little bit more about yourself and how you've landed where you've landed.
[00:00:21] Sanjana Sathya, Co-founder at Thrizer: Yeah, absolutely. Well, thank you so much for having me. I, you know, have always been a huge advocate for mental health. So it's kind of really my personal journey that led me here. You know, in the past with Forthriser, I've been a part of other healthcare and tech companies, and it kind of felt like the right, you know, professional marrying of the two, but really my personal experience has been that, you know, I've, I've been an anxious person as, as long as I can remember.
Like, it's just who I am. It's been who I am. And it wasn't until a couple years ago that I went to therapy for the first time myself and got diagnosed with generalized anxiety disorder. So that's where I was like, oh, so there, there's this thing, right? And there's, there's something that I have to navigate through.
It's not something I can just shun and push away. It's really a part of who I am. And that's where my journey with therapy began. And so I, you know, went to consistent therapy, still go to therapy and really saw the value of that. But at the same time, I was seeing an out of network provider. Who, you know, would issue super bills, and I would try to submit them, get the reimbursement, and, and failed.
And I never heard back from insurances, kind of went into this black box, and it was, it was tough to be able to, to sustain therapy, because I wanted to continue with her, but financially it became a burden. That's kind of around the time that I heard about Thryser as well. So I actually used Thryser as a client first.
You know, my co founder, Ronak, is the one who founded it back in 2022. He had a very similar story to me of going to therapy for a long time and navigating Superbills. And He just kind of got fed up and was like, if I'm dealing with this, then everyone else is, right? And I was like, yes, well, for sure I'm dealing with it.
And so that's really what brought me to Thryser. And it's, you know, I've been here for about a year now, and it's just been the best experience. And it's, yeah, it's definitely something that I, I care a lot about. Therapy has been so impactful in my own life, and I would love for everyone who wants to access it to be able to without finances being the reason that they can't.
[00:02:32] Gordon Brewer: Right. Right. Yeah. I love that story. And I think what you, what you speak to is, you know, having, having been in practice myself for, oh gosh, nearly 18 years now. One of the things that we do run into is people that are, you know, wanting to use insurance, which we all, most of us all that have our health insurance, we want to be able to use it, particularly for therapy and mental health issues, but not.
It's not always possible for the therapist to be able to be in network. And so, and this is something I talk about in our in my mastermind groups, just about using super bills as a way to allow people to Pay you directly, but then giving them a super bill to possibly get reimbursed by their insurance company.
And so, yeah, I love the, I love this concept and, and you're right. I think a lot of people run into problems with that. So feed us your knowledge about
[00:03:40] Sanjana Sathya, Co-founder at Thrizer: all of this.
[00:03:42] Gordon Brewer: Yes.
[00:03:43] Sanjana Sathya, Co-founder at Thrizer: Yeah, it's, you know, I think, as I've joined Thryser, I've really gotten to have so many conversations with therapists to learn about their experience, and you're absolutely right, like, being in network when insurance doesn't support you whether that's, you know, all the admin work, whether that's the low reimbursement rates, there is just clawbacks and audits, and there's just so many things that just make it impossible, honestly, for, for a therapist to stay in network for the course of their career.
At some point, people will consider going out of network. At the same time, if we're trying to say, hey, we want to keep mental health and therapy be accessible, we really have to lean on things like out of network benefits. And it's honestly a pretty reliable, you know, mode of financial help if we're able to figure out a system that works.
And Superbills, you know, I get this question a lot. It's like, I provide my clients with Superbills, like, why, why do we need Thryser, right? And, and the reason is that, you know, Super, but like, first of all, clients don't want to deal with insurance, right? If they're already seeking care and they're, you know, taking time out of their days to be able to say, Hey, I want to be there with my therapist.
I want to focus on my growth. It can feel really intimidating and scary, honestly, to say, Hey, now I have to request a super bill. I have to figure out where to put it in the insurance portal. You don't get a confirmation email when you submit a super bill, right? So it's not like, hey, we received it and we're working on it.
There's no way to track your claim online, right? And if you're trying to get on a call with insurance, you know, you're going to be put on hold. You might find someone who'll tell you your claim status, but. They really won't. First of all, you won't even know, like, how much am I going to get back in reimbursement because that's very much a coveted, you know, black box.
And finally, after maybe the claim gets approved, you have to wait four to six weeks for that check in the mail, right? And then you have to make sure the check doesn't get lost. So then you have to deposit it. It's just can feel really overwhelming and complicated. And I feel like Even if a therapist provides a super bill, a client might say, Hey, insurance is not going to have my back.
I'm not even going to submit a super bill. Right. Because it can just feel like this long process. And down the line when, you know, even in the beginning, if they're able to afford the therapist rate, Maybe down the line, you know, six months, 12 months in, you're like, Hey, actually, now I feel like the financial burden is catching up.
And I want to stop therapy. And I think my big hunch is people stop therapy because they can't afford it. I don't think it's because they're not getting value out of it. Right. And so that's where, you know, Thryser comes in to really try to help all of this and, and at every point, kind of, I pointed out the journey for a client.
There's a friction point every, every way, every point of the way. So that's what we really try to address to make it it. you know, super easy for them and also have it be a tool for clinicians to be able to say, Hey, I'll help you navigate it for you. Cause I have Thryser and they'll take care of everything for you.
All I really have to do is show up to sessions and that's it. So that's pretty much, you know, kind of our mission to make everything super seamless.
[00:06:52] Gordon Brewer: Yeah, that's I love that concept. And I think it's it's also, if you, if, if we think about it by providing that, Through Thryser, we're providing our clients a very valuable service and that they're not having to do the legwork of trying to contact their insurance company about submitting the super bill and then not knowing what, what's going to happen with, with everything.
Yeah, sure.
[00:07:19] Sanjana Sathya, Co-founder at Thrizer: Exactly. Yeah.
[00:07:20] Gordon Brewer: Yeah. So I'm, I'm curious on the, on the therapist side of things, and how does it generally work if we want to provide super bills to people and what's the process, at least through Thryser?
[00:07:34] Sanjana Sathya, Co-founder at Thrizer: Yeah, yeah. So typically a therapist is able to provide a super bill from their EHR, right?
There's a lot of EHRs these days have this feature where they're able to just easily export a super bill. And at that point, you know, the, the client would need to submit it to insurance. So. What we found is that there's kind of two ways that a therapist typically likes to help their clients. One is a little bit more high touch and a lot of other one is like, Hey, I want to be hands off, but I do want to provide a resource to my clients.
Right. So the first one is our payment platform. And so if they want to provide courtesy super bill uploads for their you know clients, that's the right option for them. And then we also actually let clients just pay a copay in that world. So. To break it down further, essentially a therapist would use Thryser's payment platform to charge their clients after sessions.
The benefit of doing so is that an out of network claim is automatically submitted to insurance as soon as they charge a client. So there's no need to provide their client with a super bill and have them submit it. We manage the claims end to end. So, you know, if you know, insurance is like, hey, we need more follow ups from you, We'll be on the phone with them, not the client or the, or their clinician.
And the other neat thing is that we actually let a client just pay a copay for their sessions while we cover the rest of the therapist fee and then wait for reimbursement on the client's behalf. So that's really a way that we're different from a lot of the other people who are trying to, you know, expedite and make the claim submission and management process easier because our hunch was that Even hearing, hey, you have out of network benefits, but you have to wait four to six weeks for that check in the mail isn't enough, right?
And that's kind of what we heard from people, right? That doesn't really help them access therapy today. And the reason a lot of clients would even see an in network provider is because they just get to pay a co pay. And so if we're able to kind of simulate and create that in network experience for them while Clinicians still get their full rate up front.
That's kind of like a win win for both situations, right? And so that's how that payment platform world works
[00:09:44] Gordon Brewer: Yeah, that's, that's great. I love that. I love the concept. And, you know, one of the things and this, I can say this from just my own experience, and I'm curious as to how things like this would be handled, particularly for therapists.
I know I can think of an example where we had a clinician that was out of network with a particular insurance company. We gave the client a super bill. They paid for their, session up front. We gave them the super bill. They sent it into their insurance company, and then the insurance company contacted us, the therapists, wanting all their credentialing stuff.
So yeah, so how does that usually work with that sort of thing? So it was almost like they were trying credentialing process with that insurance company when we just wanted to remain, you know, out of network.
[00:10:41] Sanjana Sathya, Co-founder at Thrizer: Yeah, yeah, that's, that's. A bizarre experience. Typically when we're able to say, hey, a clinician wants to be out of network, it should be as simple as here's the super bill.
I've made sure to put the client's diagnosis code. I've made sure to put a CPT code here, the sessions that we've had, and here's how much I've charged. And here's my NPI and practice information. That is enough for an out of network claim. At that point you submitted to insurance and they shouldn't ask any questions.
To be fair though, insurance. can be finicky and honestly shady at times, right? So what we've seen recently is a lot of insurance companies asking for documentation, asking for notes and stuff like that, which typically just doesn't happen. And honestly, our hunch is that it is just their way of delaying and denying claims.
And so that's where, you know, if we see this happening as a trend and as kind of like bulk claims asking for this. That's when we really go to bat for both the clinician and the client to figure out what's happening. And we get on, on the phone with insurance and we're like, why are you asking for this?
What do you need from us? So that can at least be something that the clinician, the client doesn't need to handle. We're, we're handling it for them. But it rarely happens that we need to enroll a provider to be an out of network you know, a Clinician typically were able to submit the super bills and not have too much of a hassle in getting that approved.
[00:12:10] Gordon Brewer: Yeah. Is that also run into maybe insurance companies trying to renegotiate the rate?
[00:12:18] Sanjana Sathya, Co-founder at Thrizer: Yeah, so we actually don't influence the rates at all, right? So we're not involved in basically saying, Hey, like, you know, we would love to do that. I would love to say, Hey, like, let's make sure that, you know, out of network rates are fair and you know, actually a good, a good amount of money that clients are getting back.
But unfortunately we don't have that kind of influence. We really just submit the claim. And so in the out of network setting, there's, there's not much that we can do to really influence the rates that, you know, People are reimbursed.
[00:12:47] Gordon Brewer: Right, right. So what, what sort of and this might be a hard question to answer.
I don't know what sort of percentage of people are getting reimbursed for their, For their sessions and that sort of thing.
[00:13:02] Sanjana Sathya, Co-founder at Thrizer: Yeah. So the percentage is actually very high. It is, you know, we, the first question we get is how many, what percentage of people end up having out of network benefits, right?
So just from the people who reach out to us or clinicians who come to us with their clients, about 70 percent of them end up having out of network benefits. And that might be a skewed number because. You know, it doesn't necessarily then mean that 70 percent of the United States has out of network benefits, right?
So we try to educate on that. But if a client has a PPO plan you know, they Typically and usually will have the out of network benefits there are only a few plans that don't have out of network benefits like HMO plans don't have it medicare and medicaid don't have it but we always recommend that if you don't know if you have out of network benefits just check just make sure to see if you have a plan From there, once we've able, we've been able to verify that a client has an, has out of network benefits, it's pretty smooth sailing from there.
So the denial rate is pretty low. I would say it's less than like about 5 percent or even less, like 2 to 3%. And at that point, it's usually just because there's like a small fix that we can make with the claim, resubmit it, and it kind of goes through after that. It's, you know, it's only when there's just like, large scale that a provider or clinician or, you know, insurance company is like, oh, like we're going to deny claims.
And then at that point we kind of need to figure out what's happening, but that rarely happens in the situations that we've seen.
[00:14:29] Gordon Brewer: Right. Right. Yeah. So with with I'm, I'm sure you've got also ways, maybe scripts, that kind of thing of being able to explain to clients how all this works.
[00:14:40] Sanjana Sathya, Co-founder at Thrizer: Yeah.
Yeah, we do. It is it, we actually have like a A lot of just education on out of network benefits because we understand that it can feel new and complicated both for clinicians and clients, so we provide like, hey, here's how out of network benefits works and like, even for clinicians who want to use Thryser, there are scripts of how to explain Thryser to your clients, right?
And so the way that we typically like to explain it to clients because, you know, A lot of people don't understand how insurance works is, basically, you have an insurance plan, if you see a clinician who is in network with you or, you know, accepts your insurance, you will be using your in network benefits.
But, just because you're seeing a therapist in this case who doesn't accept your insurance doesn't mean that you can't ask for reimbursement, and that's where the out of network benefits comes in. So, you still have these benefits in your plan that, Even if you see a clinician outside of your network, you will be eligible to receive some relief from insurance.
That though is a little bit more intensive on you to handle by yourself, right? That's where instead of, you know, if you were seeing a therapist who's in network, they will take care of the, you know, insurance claim for you. They'll submit it to insurance. You don't have to worry about anything. You just pay a copay.
Here you have to ask for a super bill, you have to submit it to insurance yourself, and you have to wait for a check. And so that's how we explain it. And at that point, clients were like, okay, I'm, I don't want to do all that. And then that's where we educate them on, Hey, but here's where Thrizer can help you.
[00:16:14] Gordon Brewer: Right. Right. You had mentioned about the co pay how does that work?
[00:16:20] Sanjana Sathya, Co-founder at Thrizer: Yeah, so the way that out of network reimbursements work is basically insurance companies set this thing called an allowed amount. So, an allowed amount is a very niche, like, out of network reimbursement term. And what that means is that is the maximum they're willing to reimburse for a particular session.
This allowed amount changes by client. It changes by even geographies and everything. So that's that coveted number that we often, you know, we, we don't get that before we submit a claim. We kind of have to wait for it after we submit a claim, but we're able to kind of estimate at it. But that allowed amount is a flat number, so it's not a percentage based thing.
It's like, even if a clinician charges 200 or 400 for a session, insurance can say, Hey, but we're only going to cover up to 150, right? And then whatever the, you know, reimbursement amount isn't covered, the difference between the clinician's rate and the reimbursement amount is what the client will end up owing.
So let's say that allowed amount is 150. the clinician charges 200, the co pay in that case would be 50, or if the clinician charges 400, the allowed amount is still 150, they would pay 250 in that case, right? So it's really just the difference between the two. And it gets even more complicated because you know, a lot of times a client will have this thing called a co insurance responsibility.
So even if The insurance that's an allowed amount at 150. They might say, Oh, but you're responsible for 20 percent of that 150, right? We're only going to cover 80 percent of that 150. So in that case, they only cover 120. The client's still responsible for 30, and there's still that 50. That's the difference between the 200 and 150.
So the client is actually paying 80, right? And so the math can get a little confusing, but that's why we have an instant benefits calculator that does all of this for, for the client and the clinician so that they don't have to sit there and figure all this out. And that's kind of the number that we present to them.
We'll say, Hey, you have a deductible. That's After you meet your deductible, your copay is estimated at 80, and that's where we do all the math for them.
[00:18:32] Gordon Brewer: Right, right. Yeah. So in using the platform, it's really, at least the way you're describing it, it's almost like no different than using like in network insurance.
I mean, you pay the co pay, the co insurance, and then everything else is just handled on the back end.
[00:18:53] Sanjana Sathya, Co-founder at Thrizer: Yeah, exactly.
[00:18:54] Gordon Brewer: Yeah. Yeah, that's great. That's great. Well, Sanjana, I need to be mindful of your time. Tell folks more about how they can find out about Thryser and also I think you said that there's a free trial that you guys are offering as well?
[00:19:11] Sanjana Sathya, Co-founder at Thrizer: Yeah, yeah, so we are offering a free trial for listeners of this podcast, so as a clinician, if you want to try out our payment platform, you can do so completely for free we're letting you you know, try us out for no credit card fees for the first 2, 500 in payments that you do, so that's a great kind of way to get your feet wet.
If you want to try out with one or two clients, see how the process works, check out our instant benefits calculator. It's kind of a great way to, to do that. And I, I know I've dropped a link for, with that with you Gordon. So if you're able to share that with this podcast, but if not, you can also go to thrizer.
com and make sure you enter Gordon as your free trial code. So you'll be able to get that credit then.
[00:19:56] Gordon Brewer: Right, right. Well, that's so kind of you to offer that and we'll have links in the show notes and the show's summary For people to find that easily. So any any parting thoughts here as we kind of wrap things up?
[00:20:11] Sanjana Sathya, Co-founder at Thrizer: Yeah, thank you so much for having me I think this was you know It's always a I feel a sense of responsibility to share how out of network benefits work because there's just so much just mystery around it, right? And so I love these podcasts because we're able to actually break it down, do the math for people and, and walk them through it.
And, and I forgot to mention the other service that we have. So if you didn't want to stay hands off, and we were talking about that a bit earlier we also have a Superbill uploads option for you. So in that case, as a clinician, you stay completely hands off. You can just give a client a Superbill. They can create their own Thrizer profile, verify their own benefits, and upload their super bills onto that.
So that way you're completely hands off. So you don't have to bill through Thrizer. In that case too, we actually offer an instant reimbursement. So, if they did want to say, Hey, like, I don't want to wait four weeks for that check in the mail. I just want it right now. They can actually request it for an extra fee and at that point they get the reimbursement directly to their bank account in one to two days instead of waiting for that four to six weeks.
So that's also an option available to you. So whatever you know, makes more sense for your practice you have that flexibility to choose.
[00:21:24] Gordon Brewer: All right. Right. Yeah, that's great. I'm so excited about this and I'm hopefully we'll have some more conversations here in the future.