Alternative Reimbursement Strategies

The Right Price for Your Health Care.
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Consider the Alternatives.

MedBen’s alternative reimbursement strategies give self-funded employers the same access to quality care as preferred provider organizations (PPOs), but with greater savings.

Reference-based pricing and direct-to-employer contracting take full advantage of self-funding’s ability to better manage health care costs through lower pricing. MedBen clients who use these alternative coverage strategies spend less than traditional PPO plans and benefit from healthier employee populations. 

Fast Facts

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MedBen clients with DTE contracting or RBP plans outperform traditional PPO plans by an average of 23.5.%

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DTE/RBP clients spend an average of 22.7% less on inpatient care compared to PPO plans.

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For outpatient care, DTE/RBP clients spend an average of 30.3% less compared to PPO plans.

Reference-Based pricing
Reference-based pricing (RBP) uses Medicare pricing as the primary source of repricingMedBen will work with you to put in place a RBP strategy that pays providers a fair and reasonable fee for medical services, customized to fit your specific population needs.

With RBP, employers benefit from pricing transparency that makes it easier to predict expenses. And members can visit the doctors they prefer and still realize lower out-of-pocket costs.

Choose Your Reference-Based Pricing Options

MedBen offers RBP services that can be implemented either individually of, or in combination with, each other. Plus, we will ensure that they work seamlessly with other components of your health plan.

Straight RBP

Providers receive fair reimbursement based on Medicare pricing. And because your plan no longer has a PPO, members can go anywhere they choose for medical care.

Pharmacy Cost Plus Pricing

 Reference-based pricing strategies specifically for your prescription drug coverage.

Layered RBP

Target high-cost medical treatments, such as kidney dialysis.

Direct-to-Employer Contracting

Many MedBen clients blend their RBP plan with direct-to-employer (DTE) contracts, which promote the use of quality care through local providers. In exchange for encouraging members to visit contracted facilities, providers bill the plan at mutually agreed-upon rates.

MedBen has been facilitating DTE contracting for over a decade with doctors and hospitals across the Midwest, and we continue to gain access to more exclusive DTE contracting. This strategy ensures that when members utilize area providers, they receive the best pricing options available.

Alternative Strategies, Same Superior Service

Employers who utilize MedBen alternative reimbursement strategies receive the same superior services available to our PPO clients, such as industry-leading claims management and MedBen Analytics, our online employer dashboard. MedBen also educates your plan members about RBP and DTE contracting to help them maximize their benefits… and their savings.

Whether individual or in combination, alternative reimbursement strategies have proven to save employers significant dollars. Contact MedBen at 888-627-8683 to discuss what strategies will work best for your business.