Sept. 2021 | Get the latest from the best RBP advocates and auditors
Industry Perspectives
Omar Arif
Vice President of Business Development
RBP 2.0
Reference based pricing (RBP) tends to have a negative connotation in the benefits world. Most brokers and consultants are educated on it, understand the financial impact, and still don’t bring it to their clients. Or even worse, brokers bring horror stories to their clients to steer them away from it.
There are a million reasons this is happening. The broker had a bad experience with RBP and has completely written it off; it’s more work for the broker and client; a much deeper level of client and member education is needed; it’s anti-establishment and not for everyone; it can be uncomfortable when dealing with a member who has a balance bill or couldn’t get access to their provider; it can be contentious when dealing with big hospital systems, etc. Frankly, it’s just very different than what people are used to and that can be scary.
It doesn’t help when most of the RBP vendors out there are private equity-backed or publicly traded. Those entities tend to act in the interest of shareholders first and clients second. They have a product that saves money no doubt, but what are they sacrificing? Read more...
Client Savings
Comprehensive line-by-line claim auditing by healthcare professionals is used to uncover errors typically not caught. ClaimDOC publishes a sample of five recent client savings audit results bi-monthly. See the savings below and know that together we can make healthcare affordable.
1. East Hartford, CT
Outpatient services for the treatment of end-stage renal disease and three-day dialysis treatments
High-Dollar Services:
Dialysis Treatments (3): $67,951.25
Savings Summary:
Billed Charges: $67,951.25 ClaimDOC Allowed: $925.44 Plan Savings:$67,025.81 Reduction: 98%
2. Des Moines, IA
Four-day hospital stay for the treatment of sepsis and respiratory failure
Disclaimer – The analysis of any medical billing or coding is dependent on numerous facts, regulations, payer policies, and codes, as well as the controlling plan description. The information contained herein is intended to provide a real-life example of opportunities for savings through ClaimDOC services but is not intended to provide medical, legal, or financial advice.
Member Experience
Feedback from a Member
I'm new to the plan and had a lot of questions. My Member Advocate, Beth, was able to explain all the details of my bills. She took the time to make sure I understood the statements instead of rushing me off the phone.
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