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AblePay carves niche in health care payment arena

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It’s a familiar scenario: Doctors send bills to patients and then wait months or years to collect payment.

 

And patients delay payment because they have trouble paying the bills, often because they have high-deductible insurance plans.

Enter John Fistner, president and CEO of AblePay Health in Bethlehem, who since 2016 has been building a company designed to help both.

AblePay offers discounts up to 13 percent to people who pay their health care bills within a certain time frame – the faster they pay, the higher the discount – and negotiates a payment plan with the employee.

Health care providers, meanwhile, are guaranteed payment for the patient’s bill from AblePay, although at a negotiated discount. AblePay’s revenue is the difference between what the patient pays and the discounted amount paid to the provider.

AblePay offers its discount and flexible payment plans to businesses and individuals, no matter what health insurance plan they have.

“There’s no cost to the employer, no cost to the employees and no minimum for enrollment,” Fistner said.

But an employee or any individual must use a participating health care provider to get the discount.

1,500 MEMBERS

In the Greater Lehigh Valley, St. Luke’s University Health Network is the only provider that is participating, although Fistner said he is in talks with all major health networks in the Greater Lehigh Valley and is closing on a deal with a “major provider” in Philadelphia.

About 1,500 people have signed up to participate, and that number is expected to rise to 15,000 by the end of this year, he said.

“Our focus is the discount, flexibility on the terms, advocacy and convenience,” Fistner said.

AblePay has 10 employees and expects to double that this year as it expands nationally in strategic markets, which include Philadelphia, Pittsburgh, Orlando, Tampa, Indianapolis, Phoenix and Los Angeles.

COLLECTION NIGHTMARE

As a former workers compensation reimbursement consultant for hospitals and former chief financial officer and chief operating officer at Coordinated Health, Fistner said he saw how difficult it was for health care companies to collect payment from patients.

According to a study from the Milliman Medical Index, 72 percent of patients do not pay their health care bill within a month and 75 percent of providers mail more than two statements.

The problem of collecting payments has increased over time as deductibles and coinsurance rise and employers shift more insurance costs onto employees.

“Hospitals are collecting between 17 cents and 35 cents on the dollar on deductibles and co-insurance right now,” he said.

“They’ll get more on that from us,” Fistner said. “They get paid quicker and they know they’re going to get paid.”

MORE TIME FOR EMPLOYEE TO PAY

Here’s how it works:

<Businesses contract for free with AblePay to offer employees discounts on deductibles and co-insurances.

<The discount is valid only if the employee has seen a participating health care provider. AblePay bills the employee the out-of-pocket remainder after the claim has been processed by his/her health insurance company.

<The employee has 12 months (terms are one, three, six or 12 months) to pay AblePay. Payment can be made by check, credit card/debit card or through a health reimbursement account, health savings account or flexible savings account. The employee provides a default payment method.

<AblePay pays the health care provider a negotiated percentage of the patient’s bill.

PROVIDER SAVES TIME

Employees are automatically preapproved, but people who enroll on their own must get their credit scores checked.

The earlier an employee pays back AblePay, the higher the discount.

If a member can’t pay, “they are in the same position they would be with a hospital,” Fistner said. AblePay would pursue payment through a collection process.

Hospitals save money because they get paid sooner, even though it’s a discounted amount, and no longer have to spend time and money chasing down payment.

WAYS TO SAVE

Some employers that offer AblePay to their workforce are the city of Easton, Buckno Lisicky & Co., based in Allentown; and Stark Buick GMC based in Lower Nazareth Township.

Rob Grow, human resources director at Star Buick, said the company decided to offer AblePay during open enrollment to all 180 of its employees at its three locations.

“With insurance deductibles on the rise, we’re always looking for ways to save our employees as much money as possible,” Grow said.

Star Buick employees are not obligated to participate, he said.

Grow said he is hoping that Lehigh Valley Health Network and Easton Hospital also will participate because “that would cover the area where most our employees live.”

COMPLEMENT

AblePay sells its product directly and through brokers. Todd Linn, manager of the group benefits division at HMK Insurance in Hanover Township, Northampton County, said the agency has been offering AblePay to its employees and clients the last three months.

“It just complements the current benefit program,” Linn said.

“It’s not worth selling or seeing it as a revenue stream. It’s something that can help strengthen our relationship with the client and hopefully increase our trust with them to make them a long-term client.”

WIN-WIN

Linn said since the average deductible it sells is about $3,000, it would be helpful for an employee who has to undergo a procedure at a participating hospital to be able to spread out payments or get a discount by paying it off early.

“That’s a very good benefit that employers can offer to their employees. That seems to be a win-win for everybody,” he said.

“As more hospital systems come on board, I think this is going to be a very popular benefit in the Lehigh Valley.”

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