Reference-Based Pricing Group Health

Reference-Based Pricing is different from a traditional health plan. With Reference-Based Pricing, the employer (supported by a Third-Party Administrator [TPA] or other vendor) pays a set price for each healthcare service instead of negotiating prices with providers. There is no network therefore the provider will need to agree to accept the coverage. When a provider bills for the service, the payer remits the set amount. The TPA can facilitate the provider fee to ensure a quick claims turnaround. Reference-Based Pricing plans allow the employer to potentially reduce the overall cost of healthcare.