FAQs

Reference-Based Pricing is a unique approach to traditional self funding.

Our programs are enhanced, next-generation reference-based pricing solutions that encourage provider collaboration and offers employers a powerful and effective way to take control over increasing healthcare costs.

The old model of health care reimbursement is broken—costing you and your employees more money while producing a health plan that is not optimized with sub-optimal employee experience.

With traditional health care plans, the true cost of care is hidden. Costs are typically calculated using a top-down “billed charges” minus PPO discount model. When you use RBP, however, reimbursement is based upon fair and reasonable Medicare reimbursement rates. There is a set cost for every health care service or procedure provided through your employee’s health care plan.

The government reimburses hospitals and medical providers using a Medicare rate. This is the best price a hospital will offer for its services. Traditional insurance companies and self-funded health plans using a traditional PPO typically reimburse facility claims (inpatient and outpatient) at 2 to 3 times the cost of Medicare. This means higher costs for you and your employees.

Our programs negotiate costs to help you achieve significantly lower costs at 120% to 150% of the cost of Medicare. These plans can deliver between $.70 and $.80 in savings for each claim dollar submitted. And, pricing is transparent and negotiated up front before your employees and their families utilize services. This creates a significant price reduction, certainty and predictability in overall health care costs for you and your employee.

Below is a comparison between PPO discounts and Reference-Based Pricing. This employer was able to achieve over $2.5 million in cost savings.

We know how busy your HR Department is. That is why we have a dedicated team to support your HR team during the enrollment process. 

Not at all. The reimbursement rates that are utilized are 20% to 50% or more higher than the Medicare rate. We are fair in our negotiations and providers accept the reimbursement rates offered. This process does not affect the care being received.

We understand that navigating the health care system is challenging at the best of times and even harder when your employee (or their family member) is the patient. We have highly trained teams of Nurse  Navigators that will help your employees in all aspects of healthcare resulting in less anxiety, better outcomes, and lower costs.

The good news for employers and employees is that our next-generation RBP Plans, unlike the original reference-based pricing programs developed over a decade ago, deliver the same benefits without the negatives such as balance billing.

While 98% of all claims will result in no balance billing, on average we see 2% of claims that are questioned. These issues are turned over to and handled by a Patient Advocacy Center (PAC)

A Patient Advocacy Center (PAC) is a team of highly trained Advocates that specialize in the intricacies of Reference-Based Pricing. Members will have access to a PAC that works on their behalf should a balance bill issue arise to ensures that no excess charges are passed on to the member. The typical balance bill is resolved in less than 60 days by the PAC.

Yes, we average around 15-20% annual savings with our customized plan options. Contact us to discuss ways that you can lower your healthcare costs while providing high-quality healthcare options for your employees.

Absolutely Not! All of our programs are Non-Renewal Specific. This means that if you aren’t happy with your recent renewal—Rates, Plan Design, Claims Cost, Administrative Burdens, Service or Advocacy—we can launch better solutions at any time of the year.