Reference-Based Pricing

by | Dec 15, 2022 | Benefits, Healthcare

As healthcare costs rise, companies seek better benefit options for their employees. Referenced-based pricing (RBP) is an excellent solution. 

What is RBP? 

Referenced-based pricing helps you pay a fair price for any healthcare service. Hospitals are notorious for overcharging patients. With referenced-based pricing, the employer, through a third-party administrator, pays a set price for healthcare services instead of negotiating prices with providers.[1] With reference-based pricing, employers can save up to 30% on healthcare costs. Only pay for the services received, not the additional fees. 

With healthcare premiums soaring, keeping prices down helps employers recruit and retain employees. This also allows employers to use the saved money in other areas of their benefits plan. Self-insured companies benefit from this because it reduces their deductibles and encourages employees to live healthier.[2]

What is the RBP process? How does it work? 

The data-driven approach uses the cost of the services reported by the hospital and current Medicare reimbursement rates to determine a fair and reasonable payment to providers. First, an audit claims for errors and unexplained/excessive charges is created. Next, the actual cost of the service is identified. After that, what you were charged is repriced, followed by determining an equitable payment and margin.2

Benefits of RBP

There are several benefits to RBP! One of the best benefits is that you are not connected to any network, meaning you can go to any doctor. RBP also allows employers to budget accurately instead of guessing hospital prices. This is also a great way to maintain employees and attract potential employers.[3]

Save your company money with reference-based pricing. Contact us to schedule a quick 30-minute, no obligation virtual meeting to learn more and see if RBP is a good fit for your 2024 plan. Early 2023 is the time to start a positive change for 2024!