By Bill Rusteberg
In the beginning Reference Based Pricing plan members enjoyed almost unfettered access to hospital care. Hospital intake clerks were often fooled into believing RBP members belonged to hospital approved provider networks because more common than not there was a recognizable managed care logo somewhere on member’s I.D. card. What they didn’t realize was that network access was for professional care only, not hospital care.
Hospitals fought tooth and nail to collect balance bills thinking they could win every time. After all they had signed patient agreements stipulating payment in full if insurance paid short. And, hospitals knew plan sponsors would rather cave in than fight back when plan members complained and demanded the plan pay more.
That worked for a time…………then it didn’t. Hospitals were generally unsuccessful collecting balance bills and plan sponsors employed mean spirited lawyers to fight back. More employers took notice and joined the RBP revolution. And more lawyers from both sides did too.
But times have changed especially in certain geographic areas like Houston, Texas. Intake clerks are much better trained and can spot a RBP plan miles away with their eyes closed.
“Sorry, we don’t take that insurance” says the smiling intake clerk. “We consider you a cash pay customer.”
“Great!” says the plan sponsor. “Give us your best cash price and we’ll pay you before or on the day of service!” Cash prices are the lowest prices paid in 99% of all cases, beating network pricing as often as 100%. Don’t worry, the missing 1% is nothing to write home about.
The RBP revolution has been a transitory phenomenon that’s rocked the world of health care finance with a force so powerful managed care schemes are becoming less relevant and outdated. Plan sponsors who continue to cling to network plans won’t for long if they know what’s good for them. The market is moving towards a cash pay health care system where everyone wins except mean-spirited lawyers and RBP vendors who fail to recognize and react to market demands. Remember Xerox, Eastman Kodak?
All of this could not have been made possible to the extent that it has without the rise of Reference Based Pricing lead by wild and crazy health care intermediaries, mean spirited lawyers and “Mad-As-Hell-&-I’m-Not-Going-To-Take-It-Anymore! plan sponsors