Reference based pricing is a strategy employers can integrate into their health plan that determines the maximum amount it will cover for a procedure. Often the maximum amount allowed in the plan is calculated based on a percentage of Medicare allowable charges, i.e.. 135% of Medicare.
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Once the maximum amount is determined, providers are asked to accept the RBP payment as payment in full. If a provider refuses to accept the payment it is often negotiated by the administrator to a reasonable and agreeable amount. The intent of RBP is to help stabilize the cost of healthcare.
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For example, the cost variance of an x-ray could range between $30 and $1300, or sometimes more, even though the procedure and quality of care is the same. A plan utilizing RBP eliminates the variance in price with a set amount ensuring the employee and the plan aren't being overcharged and the provider still receives fair payment. It's a win for everyone.
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EmployersRBP helps employers achieve optimal savings and cost management while still providing affordable, quality care to their plan members.
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EmployeesRBP stabilizes the cost of care so employees can better determine their out-of-pocket expenses & encourages members to be proactive in managing the cost of their care. |
DoctorsRBP sets a fair price for payment therefore creating a more competitive market that is focused on providing quality care at a more affordable cost.
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