By Bill Rusteberg
Aetna has been selling Reference Based Pricing plans alongside their PPO network plans for years but nobody noticed.
Hospitals and doctors rejecting Aetna network membership are paid 105%–140% of Medicare allowable charges. Aetna pays in-network providers more.
In order to make plan sponsors pay more for health care and turbocharge profits, plan members seeking less expensive care through renegade non-conforming providers are punished with higher out-of-pocket costs. Steerage is a strategy. No plan member on the planet wants to pay more for less.
Meanwhile in the pure Reference Based Pricing world plan sponsors pay less for more and plan members do too.