Source: Milwaukee Business Journal 

By Brian Marsella

April 17, 2024

More than half of Wisconsin companies offer health insurance to their employees, covering more than 3.1 million residents. If you’re one of these employers, you’ve felt the pain of skyrocketing health care costs. What was once an attractive, differentiating benefit for your people and job-seekers has become a challenge that is falling short for all.

In the last five years, family coverage premiums have increased by 22%, reaching almost $24,000. Employees contribute around 25% and employers cover the remaining 75%. To keep down the prices paid through the payroll deductions, many employers have had to move to higher-deductible health plans, which can leave employees feeling less covered and more exposed. For many families, paying for health care – premiums, deductibles, and out-of-pocket fees – has become a stressful burden that is taking a toll on both their health and household budgets.

More than four in 10 adults (43%) say they or a household member has put off or postponed care due to cost. Postponing care and early intervention often means a patient will require more intensive treatment down the road when they’re sicker, resulting in unnecessary suffering, bigger bills, higher overall costs and compromised workplace performance. More than half (52%) of insured Americans say paying for medical bills has been stressful, with nearly all of them (92%) claiming the stress has affected their physical and mental health.

An entrenched health care problem warrants new payment solutions

Various payment solutions have emerged to help mitigate the high cost of health care, including medical credit cards and spotty high-interest payment plans, neither of which relieve cash-strapped families, and could ultimately do more harm. At HPS/PayMedix, headquartered in Milwaukee since 2005, we have developed an alternative that provides employees with interest-free payment plans covering any deductibles and out-of-pocket expenses they can’t afford at the time of care. At the same time, we ensure the provider is paid in full immediately, making it easy for patients to obtain the care they need when they need it.

We do this by bringing employers and provider networks together to work out a deal that truly helps everyone involved:

• Hospitals, clinics and other providers are immediately paid in full for a patient’s care upon the bill being adjudicated by the administrator (or processed by the administrator). Providers no longer spend time and money on the patient portion of bill collection.
• We take over the financial relationship with the employee. We start by simplifying the red tape of health care billing, providing them with one easy-to-understand balance and explanation of benefits (EOB). We call it the SuperEOB.
• Employees can pay their balance over time with zero interest up to their out-of-pocket maximum.
• Employers can provide a meaningful benefit again, and a safety net for their employees.
• Third-party benefit administrators have a new, more attractive benefits package to help employers save money and do right by their employees.

Most importantly, health care becomes vastly more affordable to families than it has been in the recent past. Families live healthier, happier and more productive lives, and health insurance is a benefit again.

When a payment solution works, employers return

PayMedix gives 150 self-funded employers and just over 19,000 of their employees across Wisconsin access to this payment service at 100-plus hospitals and 28,400-plus physicians. Metropolitan Associates, one of the largest property management firms in southeastern Wisconsin, has used PayMedix for its 99 employees for 15 years.

“Managing medical bills can be tough, there are not a lot of companies that front the bills for their members, but PayMedix does. It’s a big deal,” says Metropolitan Associates’ HR Director Jared Ehmcke. “Collaborating with PayMedix not only streamlines my responsibilities but also brings peace of mind to our employees and their families.”

As health care costs soar in Wisconsin and the entire country, employers offering PayMedix have mitigated the blow. Their annual health care cost increases are trending far below the industry average – nearly one third to one half by comparison, according to PayMedix data.

• 39% of our employer clients have used our service for more than 10 years; we have a 95% annual employer renewal rate
• We’ve grown the number of employees covered by 55% over the last two years
• Our workforce has grown by 34% over the last 2.5 years, mostly greater Milwaukee residents
• Our provider network has grown by 55% since 2020
• Since 2008, we’ve processed more than $5 billion in medical payments, and 91% of our members feel our SuperEOB significantly reduces the confusion of billing, leading to a net promoter score of 75 (nearly world-class).

We’ve made a positive impact, but there’s still a lot of work to do to bring down Americans’ health care costs. We need to keep working to make it easy for families to get care, pay for care and understand what they’re paying for. Working together, we can do it by challenging conventional assumptions and ensuring everyone not only has coverage, but can afford to use it, making their number one workplace benefit the true benefit it was meant to be. In light of this, our patient financing and simplified billing can now be used with other networks/carriers. Please see our website for more information.

If you’re interested in learning more about HPS/PayMedix ask your broker or contact us directly.

Health Payment Systems (HPS) is a privately held PPO network in the state of Wisconsin. HPS is the parent company to PayMedix, an EOB consolidation tool known as the SuperEOB that serves all contracted providers and enrolled members. The PayMedix single-statement billing helps families combat confusing and unaffordable medical bills, while its guaranteed payment model eliminates provider collection costs and risk.