How is this possible? This price includes the cost of the provider, the facility and the anesthesiologist. MediBid can also develop RBP plans that split some of the savings with the plan member, which incentivizes consumer healthcare decisions.
With MediBid, the employer gets a guarantee of no balance billing on that bundle of care. With U. Reference-based pricing is the alternative that multiple states have already chosen, and it could be the start of a trend. MediBid can reduce employer healthcare benefit costs by 38 to 60 percent, and reference-based pricing is a primary tool in achieving those savings.
Taxpayers win with medical reference-based pricing Reference-based pricing, or RBP, is gaining traction around the U.
RBP gives employers more control over their healthcare costs — With traditional insurance plans, the employer pays what the plan tells them to pay, and insurance companies are notoriously secretive when it comes to how these prices are produced. With RBP, though, the employer determines what they will pay for any procedure, using Medicare as the anchoring point.
Therefore, a comprehensive communications plan and support resources are critical to any RBP rollout. Not all providers will be open to accepting RBP as payment in full. In fact, some providers may refuse outright to accept patients with RBP plan coverage or may require payment in full upfront.
An experienced RBP third-party administrator can help manage negotiations with providers and steer employees to participating facilities. In addition, there are compliance issues to consider. In addition, plan documents and communication materials must be updated so employees, providers and administrators all understand how covered charges will be paid.
Litigation risk is another concern. To date, there have been eight federal RBP lawsuits across the country. Most have been settled or sent back to the state courts. These suits have typically centered on the following:. In addition, there were accusations of fraud relating to statements to participants that providers will accept the reference price payment as payment in full.
Typically, the cases with jury trials resolve in favor of the defendant, as juries tend to be very sympathetic to perceived overcharges. Finally, there is the question of plan structure. As noted previously, the most common reference point is Medicare, which is able to set relatively low prices due to its buying power and access to actual hospital cost data.
So, even with a markup to the Medicare rate, the reimbursement is far less than traditional network discounted prices. In each of these cases, the administrator will research local costs and work with the employer to determine the reference points. RBP is still a relatively new solution to a long-term problem. And because prices are capped in advance, both the employer and the participants are better able to estimate their expenses.
From the employee perspective, RBP enables patients to know — in advance — just what a service or treatment will cost them. If your client chooses to adopt an RBP plan approach, you and the RBP TPA must work with your client to educate employees on how the health plan works and how to use it cost-effectively. Although workers still may not welcome the change, understanding the rationale behind the change may minimize complaints and concerns. This, of course, will depend on the structure and reference point selected.
For employers adopting the no-network approach, workers can see any provider they choose — but the burden falls on workers to shop for their care. For participants in in network plans, maintaining a list of participating providers will depend on which pricing model the employer has adopted.
Workers will need to learn to contact the TPA, who ideally will intercede with the provider on their behalf. A comprehensive, year-round communications plan is critical to ensuring employees and their family members learn how to use their plan appropriately. Help your client prepare print or online materials — such as FAQs — that can serve as reference tools during open enrollment and throughout the year as they use their plan.
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