pymnts visa direct healthcare payouts are drawing renewed attention as U.S. healthcare insurers face growing pressure to move reimbursements faster. New PYMNTS Intelligence research with Visa Direct shows that healthcare remains heavily dependent on paper checks and other slower payment methods, even as consumers increasingly expect money to arrive quickly.
The latest research puts the size of the opportunity into sharp focus. PYMNTS Intelligence estimates that moving healthcare insurance payouts toward insurers’ desired level of real-time delivery could shift about $252 billion annually onto faster payment rails. The findings highlight why healthcare disbursements have become an important area for payment modernization in the United States.
Healthcare Payouts Remain Stuck on Legacy Payment Methods
Healthcare insurance payments have advanced in many areas, but the final movement of money to members remains a major bottleneck.
The June 2026 PYMNTS Intelligence study, conducted in collaboration with Visa Direct, surveyed 120 U.S. healthcare insurance executives. It found that paper checks and ACH continue to play a dominant role in member payouts.
The research also found a significant difference between core claims and other types of healthcare payments. Only 22% of healthcare insurers offered real-time delivery for core claims, compared with 44% for non-claim payouts.
Core claims include payments tied directly to the healthcare insurance process. These can include reimbursements and other member payments that occur after a claim is processed.
The distinction matters because insurers may already have faster payment capabilities for certain use cases. However, those capabilities have not been adopted across the core claims process at the same pace.
PYMNTS reported in June that only about 12% of healthcare payouts overall were being delivered in real time. The research projected that figure could rise to roughly 33% within three years.
That projected increase would represent meaningful progress. Yet it would still leave a substantial portion of healthcare payouts outside real-time delivery.
Why the $252 Billion Figure Matters
The $252 billion figure represents the estimated annual volume that could move to faster rails if healthcare insurers reach their targeted level of real-time payout usage.
The underlying PYMNTS Intelligence research found that healthcare insurers want approximately 33% of outgoing payout transactions to use real-time methods within three years. The report compared that target with current adoption and calculated the potential annual shift in payment volume.
The number illustrates that healthcare payment modernization is not a small operational project.
It represents a large financial flow involving insurers, healthcare providers, members, payment processors and financial institutions. Faster movement could also change how consumers experience the period after a healthcare claim has been resolved.
For patients, the difference can be straightforward. A reimbursement that arrives quickly gives the recipient access to money sooner. A paper check or slower electronic transfer can leave the recipient waiting after the underlying claim has already been completed.
PYMNTS reported September 1 that a healthcare reimbursement taking five to seven days can increasingly feel out of step with consumer expectations shaped by instant deposits and real-time peer-to-peer payments.
Visa Direct Targets the Payout Bottleneck
Visa Direct has positioned its money-movement infrastructure as one way healthcare organizations can modernize disbursements.
The platform supports payments to eligible cards and accounts, allowing participating organizations to send funds without relying solely on traditional check-based processes.
Visa’s healthcare strategy has increasingly centered on giving insurers and other healthcare payers more digital options for reimbursing patients and members.
A September 2025 Visa Direct healthcare update described an integrated solution involving Visa Direct, Dash Solutions and Zelis. The arrangement combines Dash Digital and SpendIT SendIT technology with Zelis’ Advanced Payments Platform and Visa Direct payment rails.
The solution is designed to help healthcare payers deliver reimbursements through digital channels while giving recipients greater flexibility over how they receive their money.
Visa said eligible real-time card payments can make funds available within about one minute, although actual availability depends on the receiving financial institution and region.
That distinction is important. Real-time payment infrastructure does not mean every transaction will always arrive instantly. Eligibility, receiving institutions and other payment conditions can affect availability.
The Role of Zelis and Dash Solutions
The Visa Direct healthcare payout effort extends beyond the payment network itself.
Zelis provides the member-facing experience and connects payment activity with healthcare payer processes. Dash Solutions facilitates the disbursement through its digital payment platform, while Visa Direct provides the underlying payment rails.
This structure addresses one of the major challenges in healthcare payments: fragmentation.
Healthcare insurers often work with multiple technology providers, processors and financial institutions. That creates numerous points where a payment can slow down or require manual intervention.
The PYMNTS Intelligence research found that 82% of healthcare insurers rely at least partly on intermediaries to process member payouts. Those intermediaries can influence how quickly recipients receive their money.
Modernizing the payment rail alone therefore does not automatically solve the entire problem.
Insurers also need integrations, operational processes and payment workflows capable of supporting faster disbursements.
Insurers Are Investing in Faster Payment Infrastructure
Despite the barriers, healthcare insurers are moving toward modernization.
PYMNTS Intelligence found that 61% of healthcare insurers were improving system integrations to support real-time payments. That finding indicates that insurers are not simply waiting for consumers to demand faster payouts. Many are already working on the infrastructure needed to make faster delivery possible.
The motivation extends beyond speed.
Payment delays can create customer-service work when members contact insurers to ask where their money is. They can also create additional administrative tasks when payments need to be reissued or corrected.
A June 2026 PYMNTS report found that 61% of healthcare firms cited “Where’s my payment?” inquiries as a major payout issue. The same research found that 54% of healthcare organizations identified late-arriving payments as a major problem.
Faster payments could therefore affect more than the time between approval and receipt.
They could also reduce some of the operational friction associated with tracking, explaining and reissuing payments.
Paper Checks Continue to Create Friction
Checks remain one of the biggest obstacles to faster healthcare disbursements.
PYMNTS reported in June that roughly three out of four healthcare payouts still went out by check, while only about 5% to 12% moved in real time depending on the measurement used in the research.
Visa’s own healthcare analysis has also highlighted the continuing use of checks. A 2025 Visa Direct report said 25% of payer-to-patient reimbursements and 60% of provider-to-patient refunds were still made by check. Visa said these payments can take considerably longer because of issuing, mailing and depositing.
The problem is not limited to waiting for the envelope.
Paper payments can require additional handling, create reconciliation work and increase the possibility of unclaimed funds. They also provide less visibility than digital payment experiences.
For insurers, that can translate into additional administrative costs.
For patients, the main issue is often uncertainty about when the money will actually become available.
Consumer Expectations Are Changing
Healthcare payment expectations are increasingly being shaped by experiences outside healthcare.
Consumers can receive certain bank deposits rapidly, transfer money between accounts through digital services and make peer-to-peer payments with relatively little friction. Those experiences create a different benchmark for healthcare reimbursements.
PYMNTS reported September 1 that this expectation gap is becoming strategically important for healthcare organizations. The publication noted that payment speed, reliability and visibility are increasingly part of how consumers evaluate the experience after an insurance claim has been resolved.
Visa also reported that 57% of surveyed U.S. healthcare consumers experienced challenges with disbursements. Among those surveyed, 42% said not knowing when funds would be delivered was their biggest frustration.
The findings point to a broader issue.
A payment can be technically correct while still producing a poor customer experience if the recipient has limited visibility into when the funds will arrive.
Real-Time Payments Could Improve Visibility
Real-time healthcare payouts are not simply about replacing a paper check with a faster transfer.
Digital payment systems can provide clearer information about the payment process. They can also give recipients more flexibility over where eligible funds go.
The Visa Direct, Dash Solutions and Zelis solution allows recipients to choose among supported options, including cashing out to a bank account through Visa Direct or using funds associated with a virtual debit card and digital wallet.
This flexibility can be particularly important in a healthcare environment where recipients may have different financial arrangements.
A member may prefer a bank account. Another recipient may prefer an eligible card or digital wallet.
Providing options can make the payout experience more closely resemble other digital financial services.
Fraud and Compliance Remain Important
Healthcare payments involve sensitive information and strict regulatory requirements, so modernization cannot focus on speed alone.
PYMNTS reported that healthcare payment systems operate within a complicated environment involving regulation, fragmented technology and multiple participants.
Visa has also emphasized security features within its Visa Direct infrastructure, including tokenization, passkeys and AI-driven fraud prevention.
The PYMNTS Intelligence research found that fraud, compliance and system limitations remain among the barriers healthcare insurers face when expanding faster payouts.
That means insurers must balance faster delivery with appropriate controls.
A successful digital payout system needs to identify the correct recipient, protect sensitive information and meet applicable compliance requirements while maintaining an efficient user experience.
What Happens Next for Healthcare Payouts
The latest research suggests the U.S. healthcare payment market is entering a transition period rather than completing one.
Real-time payout adoption remains relatively low, but insurers are investing in integrations and exploring ways to move more transactions away from paper and slower processes.
The clearest opportunity may be in areas where payment volumes are high and individual transactions are relatively straightforward.
Visa’s Edward Galvin identified flexible spending accounts and health savings accounts as promising near-term areas for testing real-time payment models.
These use cases can help organizations evaluate faster payment processes while measuring practical outcomes such as customer-service demand, processing efficiency and payment accuracy.
The broader healthcare insurance market could then build on those experiences.
Why pymnts visa direct healthcare payouts Matter for U.S. Consumers
The significance of pymnts visa direct healthcare payouts goes beyond payment technology.
At the center of the issue is a simple consumer expectation: once an insurance payment has been approved, recipients want to know when they will receive their money.
The current system still relies heavily on checks, ACH transfers and intermediaries. PYMNTS Intelligence estimates that a much larger share of healthcare payouts could move through real-time methods in the coming years, with $252 billion in annual payout volume potentially shifting to faster rails.
Visa Direct, along with healthcare and payment technology partners, is targeting that gap through digital disbursement infrastructure.
The latest evidence shows that modernization is underway, but adoption remains uneven. Healthcare insurers still need to overcome legacy systems, processor dependencies, compliance requirements and operational barriers.
For U.S. patients and members, the potential benefit is easier to understand: less waiting, greater visibility and more flexibility when healthcare money is owed to them.
The Bottom Line
Healthcare insurance payouts remain one of the biggest areas where the U.S. payment experience has yet to match the speed consumers see elsewhere. PYMNTS Intelligence research with Visa Direct shows that only a limited share of healthcare payouts currently move in real time, while insurers are targeting substantially greater adoption.
The estimated $252 billion opportunity highlights the scale of the change. As insurers improve integrations and payment providers expand digital disbursement capabilities, the movement away from checks could accelerate.
The next stage of healthcare payments will be measured not only by how quickly claims are approved, but by how quickly and clearly the money reaches the people who are waiting for it.