ABOUT RBP

What is Reference Based Pricing?

Reference Based Pricing (RBP), also commonly known as Cost plus Pricing, offers self-funded health plans a defined benefit structure based on a review of or “referencing” other forms of reimbursement for Provider services. There is no defined “In-Network” list for members to look at and make sure that they must go to one of those Providers or they have an “Out-of-Network” penalty they need to deal with. All Providers are considered “In-Network” in an RBP program. It is designed to provide fair and reasonable reimbursements to Providers based on various pricing data sets, one being Medicare.

Reference Based Pricing encourages:

1. Providers to learn more about the prevailing costs of health care services

2. Consumers to review pricing information in advance

3. Both plan members and providers to take the initiative in learning the true costs of health care services and avoid the substantial     variations in pricing that can exist

4. Employee engagement and ushers in simpler, more transparent health care pricing.