Your insurance carrier has been quietly paying hospitals inflated, secretly negotiated rates for years — and passing the cost to you. Reference Based Pricing replaces that broken system with transparent, fair pricing your plan actually controls.
Instead of blindly accepting whatever your insurer secretly negotiated with hospitals, RBP pays providers a transparent, benchmarked rate — typically a percentage above Medicare — based on what care actually costs, not what a chargemaster says it does.
Illustrative figures based on industry benchmarks. Actual savings vary by claim type, geography, and reference multiplier used.
RBP replaces opaque insurer negotiations with a straightforward process your plan owns from start to finish.
An employee receives care at any provider. The claim is submitted to your self-funded plan for processing — no network required.
Instead of a negotiated PPO rate, the claim is priced at a fair, transparent benchmark — typically 120–160% of Medicare — based on actual cost data.
If a provider attempts to balance bill the employee, a dedicated advocate steps in immediately. Employees are fully protected — every time.
Reference Based Pricing gives self-funded employers a tool they've never had before — real control over what they pay for care.
Employers consistently save 20–45% on medical claim costs compared to traditional fully-insured plans. Every dollar saved goes back to your business.
See exactly what was paid on every claim and why. No more wondering what your insurer negotiated — or what they kept for themselves.
No network restrictions means no disruption for employees. They keep their doctors. They see any specialist. Coverage travels with them.
Balance billing is handled entirely by professional advocates. Employees never face a surprise bill — and they never fight alone.
Reference Based Pricing is a proven, legally sound strategy for self-funded ERISA plans. Thousands of employers use it successfully today.
When you control what you pay per claim, renewals become a business decision — not an annual shock. Your plan. Your budget. Your call.
"When we switched from a traditional PPO plan to a Reference Based Pricing plan, our medical costs went down 20%. We were able to lower employee contributions and employees paid less when they accessed care."
Across every state, hospitals are billing commercial insurers — and your plan — at multiples far above what Medicare reimburses for the exact same service. This is the markup your employees and your business are paying right now.
Medicare reimbursement = 100% baseline. Every bar shows how much more hospitals bill commercial payers for the exact same service.
Reference Based Pricing stops this. Instead of accepting these inflated billed charges, RBP prices every claim at a fair benchmark — typically Medicare + 12% — giving your plan the same pricing discipline hospitals accept from the federal government, every single day.
Employers who move to Reference Based Pricing consistently see dramatic reductions in total medical spend — without reducing employee access or quality of care.
"Employers who make the move to Reference Based Pricing consistently tell us the same thing: they can't believe how much money was being left on the table — and how straightforward the switch actually was."Talk to Jason Suchanek →
Share a little about your situation and Jason Suchanek will reach out to walk you through your options — no pressure, no jargon, just a clearer picture of what's possible.