The healthcare financial experience is proving to be just as important to how people engage with, feel about, and respond to healthcare. Today, that experience can be riddled with frustration and confusion. Notably, balance bills stemming from out-of-network care is a source of that frustration.
To tackle the issue, we launched Zelis Health Bill AssistSM in 2024 as a way for health plans to offer support and provide members with expert guidance necessary to navigate balance bills.
Fast forward, and we’re excited to share that Zelis Health Bill AssistSM was recognized with the “Healthcare Insurance Innovation Award” in the MedTech Breakthrough Awards’ Healthcare Payments & InsurTech category. MedTech Breakthrough celebrates the best companies, technologies, and products in the global digital health and medical tech market.
Zelis Health Bill AssistSM stood out for its excellence in improving plan members’ healthcare financial literacy, identifying and resolving billing discrepancies, and the ability for health plans to tap into Zelis’ team of expert negotiators to settle health bills with providers when appropriate.
Why Zelis Health Bill AssistSM Matters
Our teams partner with health plans to offer an unparalleled level of support for their members, improving the healthcare financial experience.
At a time when health insurance premiums are increasing, and the volume of balance bills is multiplying – this kind of partnership is incredibly important. According to the Kaiser Family Foundation (KFF), family health insurance costs rose by 7% in 2024. Further, the Department of Health and Human Services found that surprise medical bills for privately insured patients range from $750 to $2,600, and the American Heart Association found that 18% of US adults received an unexpected bill of $1,000 or more in 2024. Unfortunately, a Bankrate survey found that 67% of Americans can’t afford an unexpected $1,000 expense.
We believe that money shouldn’t get in the way of healthcare. That’s why collaboration is critical, and why we created this 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.
While other employee benefit solution vendors focus on patient financing and provider payments, Zelis’ dedicated navigation team works tirelessly to educate members about their out-of-network benefits, investigate billing discrepancies, and negotiate with providers to reduce out-of-pocket costs. This collaboration enhances the overall value and support provided to members, leading to better understanding of financial outcomes and a stronger member experience.
The Impact on Members
Since launching, Zelis has saved members $160,000+ and counting. Health plans that understand the value of a member-first experience are partnering with us to bring this layer of support to their members. Together, we focus on four core pillars:
- Member Guidance & Education: Zelis Health Bill AssistSM helps members unsure about their bills by providing expert education and support. Through navigation assistance, billing investigations, and provider negotiations, members gain clarity on their financial responsibilities, leading to greater confidence in managing healthcare costs and improved satisfaction with their plans.
- Expert-Led Advocacy & Communications: Zelis’ skilled health bill navigators serve as intermediaries between plans and providers, minimizing member burden and simplifying the billing journey. Their deep knowledge of various health plan structures enables smoother communication and better financial outcomes.
- Accuracy & Cost Reduction Through System Integration: By leveraging client system integration, Zelis ensures accurate benefit application and accumulator tracking. This streamlined process allows Zelis to self-service member inquiries, identify discrepancies, and seek necessary claim corrections, reducing costs for members and enhancing the efficiency of healthcare billing.
- Cost Savings: There are endless scenarios where Zelis’ investigations have resulted in claim corrections and bill reductions. Zelis has helped members who were billed incorrect amounts, members who were billed for services they didn’t receive, and members who were billed as self-pay instead of being correctly processed through their health plan. To date, Zelis Health Bill AssistSM has helped individual members save anywhere from $100 to upwards of $50,000+.
A Step Forward in Healthcare Innovation
Winning the MedTech Breakthrough Award is a testament not just to the innovative spirit and dedication of Zelis, but the trust that payers have placed in Zelis to guide their most treasured asset—members—through what is a very complex and opaque world.
We are proud to lead the charge in modernizing the healthcare financial experience for all, and we remain committed to empowering members with confidence and clarity in their healthcare journey.
To learn more about Zelis Health Bill AssistSM and how it can transform your member support strategy, visit here. Together, we can make healthcare work better for everyone.
