What is Reference Based Pricing (RBP)?

The cost of health care in the U.S. continues to skyrocket. The problem is of major concern, not only to individuals seeking coverage, but to the wide majority of employers attempting to provide cost effective health care insurance for their employees.

Healthcare Revolution

Now a growing number of companies are joining the revolution, a community of social change, coming together to upheave the status quo. Expecting to be treated fair and to pay a FairPrice. We refuse medical bills at multiples of Medicare, cramped appointments, delays in care, black box pricing, insurance companies and healthcare organizations that dictate our fate. We opt for a FairPrice alternative to traditional comprehensive medical coverage for employees.

Here's Why

Employers are beginning to realize that medical facilities are charging two, three-even 10-times the actual cost of providing health care, whether diagnostic testing, surgical procedures or any number of healthcare services. Medical facilities understand that third party insurance companies are footing most of the bill. Yet, the contractual agreements between hospitals and insurance companies typically do not allow carriers to audit hospital bills. That's right, medical facilities have been racking up charges with no oversight and no system of checks and balances. Like children left alone with a full cookie jar, medical facilities have been helping themselves to seconds and thirds because no one is looking. Is there any wonder healthcare costs in the U.S. have gotten out of control?

This lack of oversight has led to less-than-transparent marketing by insurance carriers who promote their services to prospective business customers by showcasing that they get as much as 15 to 50 percent off medical bills. What they fail to reveal is that the reduction is off of a bill that has already been massively inflated, rendering the "discount" meaningless. It is similar to the retailer that marks up the merchandise by 50 percent, only to later have a sale that gives customers 10 percent off.

Unfortunately, that has often left employers holding the bag because any small percentage off of a medical bill—even as much as 50 percent—is no substitute for covering invoiced amounts that start out at up to 10 times the actual cost to the medical procedure. All those bloated expenses get passed along to employers.

But, why not believe in a better way, a shared way through connection, focused on your employees and their doctors. Break down the barriers and create an opportunity so that all your employees have access to quality care at a FairPrice. A solution that provides a lower cost for employers and greater control for employees. That solution is self-funding through Medicare Reference Base Pricing. Here's how it works:

Traditional healthcare insurance plans are typically either "fully insured" or "self-insured" plans. Companies pay insurance carriers a monthly fee, either for 100% of premiums or for stop loss premiums, for covering their employees, but where the plan falls short, companies must make up the difference. By contrast, a self-funded plan with Reference Based Pricing provides employees with the opportunity to choose their provider, rather than being limited to any single network of providers. In addition, employees are more involved in their own care. In some cases, the cost savings for companies has been so great, it has allowed these businesses to reduce deductibles or provide other features to their healthcare insurance plans they would not otherwise be able to afford.

If you decide to choose a self-funding plan, be aware that one of your first tasks will be to determine a pay schedule. For example, you may want to base it off of the Medicare reimbursement amount plus some additional percentage. Employees will need to get involved in choosing the most economical healthcare providers, as well. So why not believe in a better way, a shared way through connection, focused solely on your employees and their doctors. Why not join the Healthcare Revolution. Join the movement. Be a part of change, be a part of a new world of undeniable first class care at a price that is transparent, that you choose. It’s bigger and better, with more value and more attention to the details that matter to you most!

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