Day: April 13, 2024

New Evidence-Based Healthcare Pricing Standard Available for Paying Out-of-Network Medical Claims

MyHealthGuide Source: Denniston Data Inc, The Healthcare Transparency Company, 4/10/2024

The U.S. healthcare marketplace needs a transparent standard that is fair to patients, providers, and self-insured employers offering health benefits to their employees.

AUSTIN, TX — In its Healthcare Pricing Guide (HPG) solution, Denniston Data Inc. (DDI) offers standardized benchmark rates by procedure code inclusive of all in-network negotiated rates for every medical service performed by every provider, from every health insurance company. These agreed-on negotiated marketplace rates can be used as the basis for fair compensation for out-of-network providers.

Continue reading New Evidence-Based Healthcare Pricing Standard Available for Paying Out-of-Network Medical Claims

RBP Pure Medicare Methodology Is Flawed

WellRithms Publishes White Paper Exposing Flaws in Reference-Based Pricing and Introduces Superior Alternative

“While RBP allows employers more than one way to pay a medical bill without having to establish a provider network, thereby opening the marketplace, it has still failed to provide a methodology that is transparent and understandable. RBP’s pure Medicare multiple is arbitrary and does not meet the definition of UCR pricing.”

Continue reading RBP Pure Medicare Methodology Is Flawed

Stop Loss Carrier With Bells On Their Balls Offers Participating Contract

How do you know if your stop loss carrier has bells on their balls? And what’s the implication if they do or don’t? Glad you asked………..

We just learned of a stop loss carrier that guarantees, for a premium load of 6%, a 30% premium refund if spec. claims are below 50%.

Participating stop loss contracts are not new although few brokers and plan sponsors are aware they exist.

Continue reading Stop Loss Carrier With Bells On Their Balls Offers Participating Contract