ATTENTION HOSPITALS: Rejoice and be Happy! The Reference Based Pricing battle has been won! You have been so successful in putting the Fear of God among local plan sponsors considering Reference Based Pricing that it’s had the intended effect.
Now we learn the Reference Based Pricing market is pivoting in your favor. Back stage side agreements provide additional revenue all the way up to billed charges if you’re smart enough to hold your ground in balance billing disputes.
Certain stop Loss coverage in place with a growing number of Reference Based Pricing Plans protect members against balance billing because when push comes to shove terms and conditions of the insurance coverage are triggered, covering balance billing amounts in excess of 230% of Medicare.
This is great news for hospitals!
Plan sponsors employing this strategy have silently agreed to fund disputed claims up to 200% of Medicare even though their plan stipulates payment of 120% – 150% of Medicare.
According to Reference Based Pricing sales literature our attorneys have uncovered during discovery “If the RBP vendor is unsuccessful in negotiating a settlement with the provider who has Balance Billed the Participant at their preapproved limit of 200% of Medicare, the claim is turned over to (NAME OF INSURANCE COMPANY) and the Plan and Member have no further liability beyond 230% of Medicare.”
Our recommendation is to hold firm in all balance billing disputes with Reference Based Pricing plans. Chances are better than average you will prevail beyond your wildest dreams.