June 3, 2026 – Risk Managers

Competition Among Hospitals is Rare Except In Harlingen, Texas

This is what can happen when Reference Based Pricing plans capture market share…………….

By Bill Rusteberg

Valley Baptist hospital in Harlingen, Texas has been accepting Reference Based Pricing plan patients for many years. Balance billing has been few and far between. Area Reference Based Pricing plans have been paying 120% of Medicare and in some instances less than that.

Allowed Amount Is Not The Same As Paid Amount

By Ralph Weber

The RAND study almost, kind of, sort of ‘says’ hospitals get paid 254% of Medicare by commercial plans. But does it really? If you read it very carefully, you’ll find something else.

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