The Balance Billing Myth

A seemingly valid concern about Reference Based Pricing strategies on the part of consumers is the possibility of balance billing leading to personal debt, lawsuits and ruined credit. Balance billing occurs when you don’t ask the price……………

Regarding the later (ruined credit), that can’t happen anymore in Texas. (It’s Xmas In Texas – State Passes “No Credit Ding Law”)

Now that Reference Based Pricing has been around for more than ten years, with more employers adopting the strategy and growing, what are the statistics on balance billing under Reference Based Pricing plans?

Quiz (Select the % closes to industry average balance billing %)

1._____ 100%




If you had a visit from a BUCA rep. in the past week or so, your answer will probably be #1. If you survey local health care providers inquiring if they will balance bill your RBP plan, your answer will probably be #1 too. If you ask a member of the 50% Club (Owe Medical Bills? Don’t Pay Promptly, Pay Late & Join The 50% Club) your answer will be #2.

The right answer is #4.

What about lawsuits? What do statistics show? Must be high because some Reference Based Pricing vendors scare the hell out of you with their horror stories about how bad going to court over unpaid medical bills will be, and the expense involved. (Selling Fear & Cost Plus Insurance) Well…………….guess what, the right answer is #4 again.

So now that the market has exposed the balance billing myth for what it really is, what’s holding employers back from adopting the model?