Consociate Health > Services > TPA Services > Reference Based Pricing

Reference Based Pricing

Claim review and auditing services for self-funded health plans, for out-of-network claims, or for plans that have decided not to utilize a PPO network for access to providers or facilities.

Consociate Health works with RBP solutions that are set-up to recognize the medical provider’s actual cost of delivering their services and to allow for a fair and acceptable margin above that cost.

Consociate Health only works with RBP solutions that offer effective member advocacy services and provide for plan/member indemnification upon unsuccessful appeals process.

  • 20-40% reduction in annual claim costs
  • Significant reduction in stop loss premiums
  • 2-3% appeals rate (not the member disruption many fear)
  • Cost of convenience — What is is your organization really willing to pay for the sake of convenience? If you could save 20-40% on healthcare claims would it be worth a few members being inconvenienced?
  • ID Card (or is it a blank check?) — Some plans are beginning to view their health plan’s ID card as a blank check. Plan members are accessing high cost providers (even some within PPO Networks). RBP solutions are a means of allowing members access to providers, while ensuring the plan pays a fair and reasonable amount of medical services.
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