Reference Based Pricing
What is Reference Based Pricing or RBP?
Medicare is the largest purchaser of health services in the U.S. and pays specific set prices for all medical procedures – a published “reference price,” known as 100% of Medicare. RBP plans pay the Medicare price plus 25% more, or 125% of Medicare. The plans you are probably familiar with, BUCA (Blue, United, Cigna, Aetna) or PPO plans, pay undisclosed “confidential prices” based on “discounts” off of inflated hospital billed charges causing your company to pay 275% to 350% of Medicare for every procedure.
The great thing about RBP plans is that they have 10 years of success in lowering health benefits costs 30%+ and are used by thousands of companies and municipalities.
Why Doesn't everyone do RBP instead?
The reason many companies do not elect to do RBP is because of something called Balanced Billing. Balance billing, sometimes called surprised billing, is a medical bill from a healthcare provider billing a patient for the difference between the total cost of services being charged and the amount the insurance pays.
What protection do I have against Balance Billing?
Although rare, it is possible to receive a balance bill from a provider. That’s where Claim Watcher steps in. Our Claim Watcher service provides full legal protection at no additional cost to NLA, the employer, or member to protect you from being balance billed. Our agreements attest that the Plan pays for any additional payments that are negotiated with a provider. That is, the Plan has no obligation to pay above the reference price but has the option to do so. We negotiate with providers and recommend payment on behalf of the consumer which the Plan pays because it has saved so much on the vast majority of claims that do not result in balance bills.