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, direct-to-employer contracting and fair market pricing 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 standard PPO plans alone… and with multiple benefit options, you can create a plan that meets your specific goals.
Fast Facts
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Clients using alternative reimbursement strategies spend an average of 16.7% less on inpatient care compared to standard PPO plans alone.
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For outpatient care, alternative reimbursement clients spend an average of 34.4% less compared to PPO plans.
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Fair market pricing yields a discount average of 56%, while maintaining just a 0.23% appeals rate.
Reference-Based Pricing
Reference-based pricing uses Medicare pricing as the primary source of repricing. MedBen will work with you to put in place a reference-based pricing strategy that pays providers a fair and reasonable fee for medical services, customized to fit your specific population needs.
With reference-based pricing, 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.
Direct-to-Employer Contracting
Many MedBen clients blend their reference-based pricing plan with direct-to-employer 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 direct-to-employer contracting for over a decade with doctors and hospitals across the Midwest, and we continue to gain access to more exclusive direct-to-employer contracting. This strategy ensures that when members utilize area providers, they receive the best pricing options available.
Fair Market Pricing
Fair market pricing uses annualized market data from millions of claims processed across the country to determine the right payment for billed services. Our method incorporates geographic and provider-specific benchmarks to deliver proper provider fees and maximum saving results with minimum noise.
Most provider payment questions are resolved with no further action. But should a provider have questions or file an appeal, our payment recommendations can be readily supported, and payment negotiations will be conducted when appropriate… with a 100% appeals resolution rate.
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 reference-based pricing, direct-to-employer contracting, and fair market pricing 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 800-423-3151 to discuss what strategies will work best for your business.
Self-funding Saves. MedBen Delivers.
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Benchmarking
MedBen Analytics' benchmarking capabilities enable you to compare your data against state and national norms and/or specific industries. You can narrow your benchmarks by plan type, number of lives and other metrics to get a true measure of how your plan stacks up.
Your benchmarking choice is immediately reflected on the dashboard content.
Straight RBP
Providers receive fair reimbursement by using Medicare pricing as the primary source of repricing. And because your plan no longer has a PPO, your plan members can go anywhere they choose for medical care.
Pharmacy Cost Plus Pricing
RBP for your prescription drugs.
Layered RBP
Target high-cost medical treatments, such as kidney dialysis.
An Extensive Reporting Library
Once you've chosen your population, reporting period and benchmark preferences, just sit back and watch MedBen Analytics go to work for you. Dozens of charts, graphs and tables, instantly generated. Our financial, clinical, risk and savings reports show you what is working with your plan while highlighting areas of potential improvement.
FSA Store is the largest online marketplace for guaranteed FSA-eligible products, helping flexible spending account holders manage and use their FSAs and save on more than 4,000 health items using tax-free money. You can pay for purchases using your MedBen FSA debit card so they are automatically noted on your account balance.
Use these convenient links for finding FSA-eligible products and calculating your FSA tax savings. FSA members can check their current account balances by visiting MedBen Access or downloading our mobile app from the Apple App Store or Google Play (search for "MedBen").
Use this secure 24/7 service portal to access claims and benefits information. MedBen Access enables you to:
- Check claims status
- Review benefit coverages
- Download explanations of benefits (EOBs)
- See deductibles, out-of-pocket costs and calendar maximums
- Look up drug information, compare local pharmacy prices and check availability of lower-cost equivalents
- Review FSA and HRA activity and balances
- Check wellness exam and screenings compliance (for WellLiving members)
If you need assistance logging in to MedBen Access or using its features, please contact MedBen Customer Service at 800-686-8425.
MedBen Access is also available as a mobile app with the same great features! Download it from the Apple App Store or Google Play (search for "MedBen").
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Please register to download the Client Report. Thanks!
Frequently Asked Questions about using the debit card (PDF).
Download a list of participating pharmacies, discount stores and supermarkets that can identify FSA-eligible items at checkout using an Inventory Information Approval System (IIAS).
Download a list of participating pharmacies, discount stores and supermarkets that do not use IIAS, but 90% of whose sales come from medical care items (thus making them FSA-eligible).
Medical Solutions.
MedBen will work with your clients to find the best solution to meet specific employee population needs. Increasingly, organizations are going outside the PPO box and turning to direct-to-employer contracting, reference-based pricing, and other alternative reimbursement strategies with set pricing that makes it easier to predict expenses. And their members can visit the doctors they prefer and still realize lower out-of-pocket costs.
Pharmacy Solutions.
MedBen will work with your clients to find the best solution to meet specific employee population needs. Increasingly, organizations are going outside the PPO box and turning to direct-to-employer contracting, reference-based pricing, and other alternative reimbursement strategies with set pricing that makes it easier to predict expenses. And their members can visit the doctors they prefer and still realize lower out-of-pocket costs.
Medical Solutions.
MedBen will work with your clients to find the best solution to meet specific employee population needs. Increasingly, organizations are going outside the PPO box and turning to direct-to-employer contracting, reference-based pricing, and other alternative reimbursement strategies with set pricing that makes it easier to predict expenses. And their members can visit the doctors they prefer and still realize lower out-of-pocket costs.
Pharmacy Solutions.
MedBen Rx follows a simple philosophy: The client's money belongs to the client. Our pharmacy solutions are designed to get members the right drug at the lowest cost, with total transparency to the employer. These include:
- Pricing solutions that ensure clients pay just what the pharmacies pay.
- Appropriateness solutions to find the most effective drugs at the best cost.
- Access solutions that give members new ways to lower their drug cost.
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.
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