Help Clients Answer These 3 Reference-Based Pricing Questions

By Matthew Johnson

As employers look for new ways to contain health care costs, more are looking into reference-based pricing – the model that sets top prices for specific prescriptions, procedures and services. Because this model is still relatively new, your clients (and their employees) may have more questions and require more education than with other plans. To help you prepare, here are the three most common employee questions to anticipate when clients are moving to RBP.

1. Will my costs increase?

Whenever an employer changes their plan, employees understandably want to know why and whether their costs will increase. Your education efforts should address these questions head-on, always focusing on what’s in it for the employee.

The primary reason employers adopt reference-based pricing is cost. Because employers won’t have to accelerate or increase their contribution levels, employees’ costs will also typically go down.

2. Can I still see my doctor?

Not surprisingly, the next question we typically hear from employees is: “Can I still see my doctor?” This is always an important issue for your clients, and the answer is “yes.” Employees can see their doctor or they can also choose a different approach. Under the RBP model, employees can take ownership of their procedure, learn about other options and then choose a different physician they’re comfortable with. Their freedom to choose is one of the big RBP model benefits.

3. Why did I receive a balance bill?

The final big question is related to balance billing. Here’s where you have an opportunity to educate clients. When they go out of the network, there is a chance they’ll receive a bill for the outstanding balance after the insurance company submits its portion of the bill. That happens under various types of plans. But under the RBP model, it doesn’t mean the charges aren’t covered. And unlike under traditional managed care plans, employees have an advocate in their third-party administrator for handling balance bill cases.

Their TPA advocate can first audit the bill for errors (which happens in up to 80% of all cases!). Then their TPA advocate will negotiate costs on the employees’ behalf. This access to advocacy is another way RBP benefits employees.

Your Role In The Client Transition

As awareness of the reference-based billing model increases, brokers must understand what makes RBP different. Not only will this help you share plan benefits with your client; you’ll also be able to address employees’ concerns directly. As with every new pricing model rollout, communication is critical to ensure success.

Matthew Johnson is a regional sales director with Trustmark Health Benefits. Matthew may be contacted at [email protected].

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