Reference Based Pricing / RBP
Is It Time to Cut The Network Cord?
About 70% of your medical claims are for facility
Standard health plans pay facilities 3 x or more what Medicare pays
RBP pays 140% of Medicare
Care Coordination is the perfect compliment to help members w/ RBP
Reference Based Pricing allows the employer to significantly lower the cost of facility claims. BUCA (The Blues, United Healthcare, Cigna, Aetna.) often pays a facility 3 x the rate of Medicare or more. And there is not necessarily any relationship between quality and cost. Reference Based Pricing allows the employer to reimburse the facility at a rate that is a lot lower, 140% to 200% of Medicare. Approximately 95% of facilities will accept this reimbursement with no negotiation. For the remainder, your RBP plan will negotiate the acceptable charge.