Reference-based pricing provides fair medical pricing, which makes it easier to discern the price of medical services. Under reference-based pricing, insurance companies, medical providers and patients all win.
How Does Reference-Based Pricing Work?
Reference-based pricing (RBP) works for everyone. Any company employee or patient is able to see any provider or facility that will accept them as a patient.
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Patients aren’t limited by in-network providers or by a specific list of providers.
Who pays the claim in Reference-Based Pricing?
When a claim is submitted, the health plan administrator will pay the claim for the services on behalf of the plan sponsor (the employer). Like a traditional insurance plan, this is the full amount of coverage minus any coinsurance, copays, or deductibles.
What is the fee schedule for Reference-Based Pricing?
Reference-based pricing is based on a reference to Medicare and other fee schedules. The Medicare schedule is the baseline for medical services received by the patient.
Frequently Asked Questions
Q: What if an employee is denied access to a specific provider because they don’t have a network attached to their plan?
A: Employees are able to access another facility or help is provided with their chosen facility.
Q: What if a provider hasn’t agreed to a reference to Medicare payment as fair and reasonable?
A: If a provider hasn’t agreed to a Medicare reference as fair payment, they can bill the patient for the remaining amount of the cost of services.
Q: What is an employee supposed to do if they receive a balance bill from the provider?
A: The best option for situations where patients receive a balance bill is to have a support system in place that will help pay the balance bill.
Deciding on the insurance plan that’s right for your company is difficult—not to mention expensive. Insurance plans using reference-based pricing has lower costs and makes it easier to provide insurance.
