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, direct-to-employer contracting and Fair Market Reimbursement 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 with multiple benefit options, you can create a plan that meets your specific goals. 

Fast Facts


DTE/RBP clients spend an average of 13.5% less on inpatient care compared to PPO plans.


For outpatient care, DTE/RBP clients spend an average of 32.8% less compared to PPO plans.


Fair Market Reimbursement yields a discount average of 71%, while maintaining just a 0.35% appeals rate.

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.

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.

Fair Market Reimbursement
Fair Market Reimbursement 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 888-627-8683 to discuss what strategies will work best for your business.

Self-funding Saves. MedBen Delivers.