According the the American Hospital Association, “Only employer-based plans regulated under ERISA may use reference-based pricing as a comprehensive payment strategy.“
Does this mean all non-ERISA group plans using comprehensive Reference Based Pricing are illegal? Cities, counties, school districts?
Fact Sheet: Reference-based Pricing | AHA
NOTE: Reference Based Pricing models benchmark anywhere from 120% to 150% of Medicare allowable while managed care contracts (PPO) average much higher than that. No one likes a pay cut if they can avoid it………………….
“How many businesses do you know that want to cut their revenues in half? That’s why the healthcare system won’t change the healthcare system.” – Rick Scott, Former CEO Columbia Hospital Corporation / HCA
