New capability guides members through the financial aspects of out-of-network care to improve the healthcare financial experience.

Boston, M.A. — September, 9, 2024 — Zelis, a leading provider of healthcare technology solutions, releases Zelis Health Bill AssistSM, a first-of-its-kind solution to give payers the ability to support plan members with out-of-network health bills at no cost to members. As health plans try to manage the complexity and volume of out-of-network billing issues, the innovation from Zelis delivers specialized expertise and scalable support to improve the member’s healthcare financial experience while reducing the administrative burden for providers.  

Health Bill Assist improves plan members’ healthcare financial literacy, identifies and resolves billing discrepancies, and taps Zelis’ team of expert negotiators to settle health bills with providers when appropriate. A recent Zelis study found that a significant portion of consumers today face challenges in paying for healthcare, and those who have trouble paying medical bills often face repeated instances of financial strain. That’s why collaboration is critical. In addition to enhancing the overall value and support provided to members, it leads to a better understanding of financial outcomes and a stronger member experience.

“Out-of-network billing is not only confusing and frustrating for members, but the process of handling out-of-network claims, member appeals, and provider negotiations adds significant administrative burden to health plans,” said Jay Deady, President, Price Optimization at Zelis. “We are proud to provide a level of support not readily available in the market today, helping health plans explain and mitigate these costs effectively.”

Benefits of Health Bill Assist:

  • The same Zelis study found that many consumers struggle with understanding their last medical bill, with only a minority reporting high understanding or understanding all aspects of the bill. Zelis helps members better decipher and understand charges related to out-of-network care and offers support with health bills, ultimately reducing financial stress and hardship.
  • Health plans handle a large volume of member inquiries and claims which can strain internal resources. Additionally, out-of-network billing issues require specialized knowledge and skills in medical claim processing, negotiation and healthcare regulations—an expertise health plans may not have internally. Zelis ensures more effective and efficient resolution of billing issues on behalf of health plans, enabling them to focus on core operations.
  • Providers often spend considerable time and resources handling billing disputes, patient inquiries and negotiations, further delaying payments and disrupting cash flow. Zelis alleviates the administrative burden on providers’ billing departments by working with members and plans directly, allowing them to focus more on delivering care.

A simplified, scalable approach

Zelis’ health bill navigation team, comprised of healthcare experts skilled in out-of-network claims processing, negotiations and benefit application, educates members to help them understand their bills, investigates to ensure the bill is accurate, applies claim corrections and attempts post-payment provider negotiations when appropriate.

  • Communication and education. In addition to online education, members receive co-branded communications after a claim is processed letting them know they have access to comprehensive bill support. If a member needs assistance, the experts at Zelis translate complicated information into meaningful insights for the member, including how healthcare claims are processed, what member protections are available under the No Surprises Act, and more.
  • Investigation and resolution. Errors are sometimes made along the claims processing and provider billing process. The Zelis team takes a deeper look at bills and can identify billing or processing discrepancies and seek claim corrections to help reduce member costs. Investigations have saved members anywhere from $100 to as much as $7,000.
  • Negotiation. When appropriate, the Zelis team attempts to reduce member responsibility through provider negotiations. By leveraging already established provider relationships, Zelis has helped members negotiate reductions anywhere from 15% to as much as 50%.

Learn more about Zelis Health Bill AssistSM.

About Zelis

Zelis is modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 750 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients. Learn more at Zelis.com and follow us on LinkedIn to get the latest news.

Media Contacts

Carolyn Edwards
press[at]zelis.com