Referenced Based Pricing – Another Self-funded option. Referenced Based Pricing is a non-traditional way of paying hospitals (and in some cases providers) based on a percentage of Medicare pricing instead of the traditional provider network contracted rates. The idea is that traditional provider network rates are much higher than Medicare rates, so Referenced Based Pricing pays somewhere in the middle of the two. This method saves costs for the member and the plan, and pays hospitals timely. The glitch is that the member can be “balance-billed” by the hospital. “Balance-billing” refers to when a hospital expects to get paid $5,000 for a service, but is only paid $2,000 by the plan. The hospital may send the balance of the bill to the patient for payment. Employers are aligning with Reference Based Pricing companies that assist in negotiating with the hospital on the member’s behalf to resolve any unpaid balances.
The hope is that Referenced Based Pricing is bringing more transparency to the cost of care and that it is a step in the right direction in addressing health care costs at large. We know for sure that if an employer implements Referenced Based Pricing, it must go hand in hand with employee education and excellent employee communications so that employees are not surprised by any balance billing practices.
Tag Archives: July 2019 Newsletter
Self-Funding 101
Self-funding has been around since the 1970’s and in today’s market, Self-funding is getting a lot of attention again as rates continue to increase, along with higher deductibles and out of pocket maximums. Self-funding is a strategy in which an employer funds employee and dependent health care claims instead of paying monthly premiums to a… Continue Reading
July—Note from Dena
Happy Summer! A common question we get this time of year is, “am I covered by my health plan when I’m away on vacation?” You can rest assured that most plans cover urgent and emergent health care worldwide! But, if you are not sure or you have specific concerns about health care coverage while traveling,… Continue Reading
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Medicare Disclaimer: We do not offer every plan available in your area. Currently, we represent 7 organizations which offer 35 products in Oregon and Washington. Please contact medicare.gov or 1-800-MEDICARE, or your local State Health Insurance Program to get information on all your options. Please note that we are required to record all phone conversations with clients who want to discuss Medicare Advantage and/or Part D prescription drug plans. We are not connected with or endorsed by the United States government or the federal Medicare program.
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Medicare Disclaimer: We do not offer every plan available in your area. Currently, we represent 7 organizations which offer 35 products in Oregon and Washington. Please contact medicare.gov or 1-800-MEDICARE, or your local State Health Insurance Program to get information on all your options. Please note that we are required to record all phone conversations with clients who want to discuss Medicare Advantage and/or Part D prescription drug plans. We are not connected with or endorsed by the United States government or the federal Medicare program.
