Health care pricing on trial: The case for reference-based pricing

Dive headfirst into the wild world of reference-based pricing, the game-changing strategy that’s revolutionizing health plan cost containment like nothing else in the past two decades of employee benefits. Imagine stripping away the cumbersome layers of national carriers and their bloated PPO network fees, paving the way for a bold, new pricing model beyond the tangled web of the government-health care matrix.

But here’s the twist: Without a pre-agreed pricing framework between health care providers and patients (or their health plans), how do we navigate the murky waters of billing disputes? Picture a scenario where, post-emergency service, a bill is slapped down with a staggering figure—900% above what Medicare might shell out for the same procedure. Sounds like the Wild West, right?

Step into the arena with us as we embark on an exhilarating exploration of the legal intricacies of reference-based pricing, alongside ClaimDOC’s Chief Legal Officer, the formidable Amy Pellegrin. Together, we’ll unravel the mysteries of what it means for a repricer to take on the mantle of co-fiduciary for health plans, dissect the legal battles waged by providers against patients and plans, and spotlight the triumphant track record of reference-based repricers in the courtroom.