Reference-Based Pricing (RBP) is often misunderstood – and that misunderstanding can lead to missed opportunities. It’s time to clear the air and tackle the most common myths head on, so more organizations can make informed, confident decisions about their healthcare strategy.
Myth #1: All RBP plans are the same.
Reality: Reference-Based Pricing (RBP) is, at its core, simply a claim pricing mechanism – but how it’s administered and supported makes all the difference. The real impact of RBP depends entirely on the strategy behind it: the level of member support, provider engagement and plan design.
That’s why no two RBP plans are alike. For almost two decades, we have been refining and enhancing our RBP solution – leveraging data, strategic partnerships and a member-first approach – to deliver one of the most effective and unique solutions in the market.
Myth #2: RBP means patients are consistently stuck with balance bills and often denied access to care.
Reality: Balance billing can occur, but is rare. In fact – thanks to our proactive model – less than 1% of our claims resulted in balance bills in 2024. And when it does happen, our RBP plans include built-in balance bill protection and a dedicated member support team to resolve it quickly and effectively.
Plus, balance billing isn’t unique to RBP – it’s a challenge across many traditional plans, including PPOs with out-of-network claims.
As for access concerns? They often are overstated by critics of RBP. Most members with RBP plans, who are supported by our member support team, experience little to no issues accessing care. And, they enjoy the freedom to see the provider of their choice without worrying about complex networks rules, or reduced benefits for non-participating providers.
Myth #3: RBP underpays providers.
Reality: RBP isn’t the wild, wild west. It’s data-driven to ensure providers are compensated fairly while keeping costs reasonable for employers. We believe combining pricing benchmarks above Medicare levels and strategic direct contracts is a winning combination to sustainable healthcare for all parties.
What other misconceptions about RBP have you heard or wondered about? Reach out to our team for assistance and sales support at sales@alliednational.com at 888-767-7133.
