8 Myths of Reference-Based Pricing

8 Myths of Reference-Based Pricing 150 150 Apostrophe Health


What is Reference-Based
Pricing (RBP)?

Reference-based pricing (RBP), simply put, is a way to pay providers using a reference point, like Medicare. When first introduced over a decade ago, visionary leaders wanted to lower costs for self-funded plans. While they were successful in lowering costs, there were gaps in the quality of care and member experience. Apostrophe studied those gaps and designed a better plan that all but eliminates them, setting Apostrophe apart from other TPAs.


Do you know how healthcare costs are determined?

Transparent RBP Plans
Rates reflect the actual, fair and regionally adjusted cost of healthcare.

Traditional PPO Networks
Rates are a discount off of arbitrarily billed chargemaster.


MYTH #1

The plan will save money, but the member experience
will be poor.

Delivering a good member experience is at the core of what we do, and our members love us for it. ➔

High-quality providers

Member Care team that actually cares

No billing chaos

Our payment strategy and $0 benefits that steer members to high-quality, lower-cost providers greatly reduce balance bills.
less than
100
Claims resulting in a balance bill*
0
Balance bills under $500**


MYTH #2

RBP plans
result in a large percentage of balance bills.


MYTH #3

Lower cost means lower quality providers.

Contrary to popular belief, costs are not correlated to quality. Members have access to a variety of providers, some with the highest quality ratings in our markets. The only difference is, we’ve negotiated fair, transparent prices. In exchange, we steer our members to them.
On the rare occasion a balance bill occurs, we support our members every step of the way with education and communication. We work with providers and negotiate a settlement to protect members from collection activity and credit reporting.
0
Balance bills settled within 30 days**


MYTH #4

If a member gets a balance bill, they’re on their own.


MYTH #5

Balance bills often end up in litigation.

We prefer to negotiate, not litigate.

And we’re pretty good at it.

the number of
Apostrophe claims
that landed in court*:
the number of
Apostrophe members
who have had a hit
to their credit*:


MYTH #6

Balance bills will ruin members’ credit ratings.

oh health yeah!


MYTH #7

Members will have to travel far to see providers.

Apostrophe plans include access to a variety of high-quality in-person and virtual providers, including primary care, urgent care, behavioral and physical therapy.

As a Certified B Corporation, we believe in business as a force for good. Our values — Simplicity, Transparency and Love — keep us aligned with our customers.


MYTH #8

It’s hard to find an RBP vendor
I can trust.

* Data is based on all Apostrophe claims over the last four years.
** Data is based on 2020 Apostrophe claims

Apostrophe is the mid-market leader in intelligent health benefits. We offer the only turnkey solution that balances savings with quality care and member experience.