PayMedix is our innovative payment platform that guarantees payment to providers, credit to patients, and simplicity for all.

PayMedix is our innovative payment platform that guarantees payment to providers, credit to patients, and simplicity for all.

FAQs About Working with HPS During Renewal Season

FAQs About Working with HPS During Renewal Season

Broker Support

1. How will HPS support me during renewal season?

  • Sell sheet
  • Blogs and other relevant content
  • Meetings

2. Will HPS staff be available for open enrollment meetings?

Yes, HPS is available for open enrollment meetings.

Discounts and Pricing

3. Why doesn’t HPS claim to offer as high of a discount as some national networks?

It is important to understand how the “discount” is calculated, and there is significant variation in this process. Some networks include non-covered services, which are repriced to a zero allowed amount, in the calculation. Some also include coding edits and claims denied as duplicates. HPS does not play these games. Ask the network exactly how the discount is calculated to compare effectively. Stay away from overall average discounts, as the overall average network utilization is likely very different from your customer’s. Instead, make sure the discounts are calculated specific to an employer’s provider utilization. If you make sure the discounts are calculated consistently and are specific to an employer’s spend, you’ll find HPS contracts are as effective as the national carriers. While our reported discount percentage may not be as high as some national networks, the cost of medical coverage is still lower. Read this article to learn more.

4. How do consumers know how much they will be charged for services?

70% of our total claim dollars are negotiated via a fixed fee.

5. What is HPS doing to control trend?

Many networks don’t take inflation into account, allowing providers to increase their prices as they wish, regardless of the discount percentage, throughout the plan year. We know this is a risk, so 97% of all of our provider contracts have inflation protection built in. So yes, unit prices may go up, but they will be at a controlled and reasonable rate. Prices often go down as well when we renegotiate provider contracts. Over the last 3 years, we have experienced an average trend of 0.5%.

6. How are our clients charged for their plan?

At HPS, we only charge when employees consume healthcare—we don’t charge per employee per month (PEPM). This rewards employers for working toward a healthier workforce.

7. How are services priced?

Approximately 70% of our total claims hit a fixed fee that is based on either DRG, Per Diems, Case Rates, Bundled Payments, Outpatient Surgery Groupers, physician fixed fee for service with the remaining claim volume hitting a percent off billed charges.


8. Many common procedures can be expensive—is there a way for plan participants to bundle payments for these?

Yes. HPS offers bundled rates with directly contracted providers, and is also partnered with several providers to offer bundled payments for common procedures such as lumbar fusions and knee replacements, saving your clients and their employees thousands of dollars.

9. What are bundled medical services?

Under a bundled payment service, providers and/or healthcare facilities are paid a single payment for all the services performed to treat a patient undergoing a specific episode of care. An “episode of care” is the care delivery process for a certain condition or care delivered within a defined period of time. Examples of potential bundled services include orthopedic and laparoscopic procedures, reconstructive surgery and spinal treatments. Many bundle providers also offer optional physical therapy post-procedure, and include warranties against complications, making the final cost even more predictable.

In a bundled service situation, a covered individual would pay a single price for the entire service (such as a knee replacement), rather than getting multiple separate bills from the hospital, surgeon, anesthesiologist, etc. The bundle will be identified as such on the individual’s monthly SuperEOB.

10. If an employee can’t pay their medical bills, are there any options other than being sent to collections?

Yes. We offer payment assistance to ensure that plan participants get the care they need. Members can take advantage of interest-free payments (with longer payment plans than offered by most providers) and other patient advocacy services to help them navigate large medical bills without breaking the bank.

11. Why would a plan enrollee’s bill be sent to collections?

The main reason a patient is sent to collections is a total lack of responsiveness. We will reach out many times to attempt to set up an interest-free payment plan. If the enrollee does not respond at all to these attempts, or refuses to pay once a plan is in place, the individual may be sent to collections. Health care bills, like all bills, are real and need to be paid. are a variety of reasons that a bill may be sent to collections if there is an outstanding balance due to HPS.

Compared to the medical systems and providers, we have many options available to plan enrollees to resolve their concerns over their medical expenses. Enrollees can contact us at 1-866-705-2383 to work through this together.

Plan Details and Accessibility

12. How do plan enrollees know how much they’ve paid toward their deductible for the year?

The Third-Party Administrator (TPA) that the employer has selected holds the balance of the deductible for plan enrollees individually (your clients’ employees and their family members). Enrollees should access the website located on their HPS ID card or on their SuperEOB to find out how much they’ve paid toward their deductible at any given point during the plan year.

13. What is a SuperEOB and how does it help plan enrollees?

The SuperEOB is designed to help combat the frustration and stress that your clients’ employees and their families (plan enrollees) experience related to confusing and unaffordable medical bills. It is a one-statement billing experience that is easy to read—it consolidates all of an individual’s or a family’s in-network explanations of benefits (EOBs) and medical bills for an entire month, regardless of how many doctors were seen, taking the guesswork and waiting out of paying for medical costs and giving them just one amount they need to pay.

Learn more about the SuperEOB

Learn how to read the SuperEOB

14. What if some providers in our clients’ network aren’t using the SuperEOB?

All providers in the HPS Network should submit participants’ claims to HPS for inclusion in the SuperEOB. If you hear that participants have received a bill from an in-network provider in error, please contact us at help@hps.md to work through this together.

It is possible that the participant has gone to a provider that is not currently in the HPS Network. If you, your client or a participant would like to nominate a provider to join our network, please contact us at help@hps.md. Also, ask the member to reach out to the provider to encourage them to join HPS—this can be very effective!

15. Why do plan enrollees only receive one medical bill per month?

At HPS, our goal is to make your clients’ employees’ medical bills as simple as possible, so we work behind the scenes to consolidate all of their bills and claims so they only get one monthly bill and only have to make one payment.

Learn more about how HPS works

Learn more about the benefits of HPS for your clients’ employees and their families

16. Why isn’t claim information on the SuperEOB? Where can plan enrollees find specific details on their claims?

The goal of the SuperEOB is to make it as easy to read and understand as possible. However, plan enrollees can still access their specific claim information. The second page of their SuperEOB offers some claim detail, while even more detail is available in their member portal account.

Learn how to read the SuperEOB

Learn how to view further claims detail (must have a member account to read)

Learn the benefits of a member account & how to create one

17. How do I, as a broker, get in touch with HPS if I have questions or need to talk to someone?

Contact Us

18. How should my clients get in touch with HPS if they have questions about their plan?

Contact Us

19. How do plan enrollees get in touch with HPS customer service to ask questions about bills or claims?

Learn More: Our Member Portal offers self-serve resources, as well as the option to contact us directly

Enrollees may also contact us through our main website or via email: help@hps.md

20. How does a plan enrollee pay their bill?

Learn More: Via our Member Portal

Learn More: Via our main website

21. How does a plan enrollee find a provider in their network?

Learn More: Via our Member Portal (Click Find a Provider on the home screen)

Learn More: Via our main website

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Want to learn more about how HPS can help you? Contact us today!