Discounts and Pricing
1. Why doesn’t HPS offer as high of a discount as national providers?
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.
2. How do consumers know how much they will be charged for services?
While many networks make it extremely difficult for consumers to find out the actual price of services prior to receiving them, we don’t. We offer transparency, as 70% of our total claim dollars are negotiated via a fixed fee.
3. Will the price of services from providers increase during the plan year?
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.
4. How are we charged for our plan?
At HPS, we only charge when employees consume healthcare—we don’t charge per employee per month (PEPM). This rewards you for working toward a healthier workforce.
Payments
5. Many common procedures can be expensive—is there a way for plan participants to bundle payments for these?
Yes. HPS is partnered with NOVO Health to offer bundled payments for common procedures such as lumbar fusions and knee replacements, saving you and your employees thousands of dollars.
6. 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.
7. 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) and other patient advocacy services to help them navigate large medical bills without breaking the bank.
8. Why would an employee’s bill be sent to collections?
There are a variety of reasons that a bill may be sent to collections if there is an outstanding balance due to HPS. These reasons include, but are not limited to:
- Our inability to come to a resolution on the outstanding balance
- Our inability to connect with the plan enrollee via email, phone or USPS mail to resolve their balance
- A failed dispute of their outstanding balance and their lack of payment to us
Compared to the medical systems and providers, we have many options available to plan enrollees to resolve their concerns over their medical expenses. Your employees and their families can contact us at 1-866-705-2383 to work through this together.
Plan Details and Accessibility
9. How do my employees know how much they’ve paid toward their deductible for the year?
The Third-Party Administrator (TPA) that you have selected holds the balance of the deductible for plan enrollees individually (your 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.
10. What is a SuperEOB and how does it help my employees?
The SuperEOB is designed to help combat the frustration and stress that your 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 number they need to pay.
Learn how to read the SuperEOB
11. What if some providers in our 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 an employee has 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 individual has gone to a provider that is not currently in the HPS Network. If you or a participant would like to nominate a provider to join our network, please contact us at help@hps.md.
12. Why do employees only receive one medical bill per month?
At HPS, our goal is to make your 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
13. Why isn’t claim information on the SuperEOB? Where can employees find specific details on their claims?
The goal of the SuperEOB is to make it as easy to read and understand as possible. However, your employees 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
14. How do I get in touch with HPS if I have questions or need to talk to someone?
15. How do my employees 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
16. How do my employees and their families pay their medical bills?
Learn More: Via our Member Portal
Learn More: Via our main website
17. How does a plan enrollee (an employee or a covered family member) 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
