Redesigning the Employer Sponsored Health Plan (ESHP) documents to support RBR.
Educating providers about how RBR plans are fundamentally different than Preferred Provider Organizations (PPOs), and their impact on physicians and hospitals. This is a critical to understand before the plan goes operational.
Full service claims administration.
Repricing all provider claims to a market based calculated reference price for each individual provider.
Utilization review, case management and quality assurance services.
Member indemnified protection against provider balance billing. This includes full legal representation.
Competitive bidding services for elective tests and procedures.
Broker relationship management.
Medical Pricepoint provides the above services and integrates sub-contracted activities on behalf of the ESHP with minimal disruption for the health plan member. In addition, Medical Pricepoint is a “plug-and-play” general contractor so that our management platform can incorporate existing health plan administrative services to avoid unnecessary disruption for the plan and its members.
Medical Pricepoint is a consumer-oriented company delivering price transparency and reduced medical costs to both the ESHP and its members.
Medical Pricepoint delivers the only market full service “Administrative Service Organization” (ASO) RBR plan that serves a fiduciary to manage and protect assets held in trust for members by the ESHP. Our business model is performance-based. Medical Pricepoint makes money only when patients and plans achieve objective measurable savings.
Our fair payment program enables self-funded plans to finally stabilize the medical benefit costs from year to year.
Medical Pricepoint reprices medical claims based on the ESHP’s fee schedule for provider services plus a reasonable profit. We respect the need for provider financial stability while we reward innovation.
Our competitive bidding service enables members to know the full cost of a test or procedure in advance. At the patient’s request, Medical Pricepoint obtains provider bids for specific services. Patients also receive important information on provider credentials and track record.
Benefits to Patients, Plans and Providers
Employer plan savings of 25-40%
Provider price transparency, competition and fair payment
Reduction in providers’ insurance billing and collection costs
Elimination of provider account receivables liability due to first dollar coverage for members
Elimination of patient financial liability for provider balance billing
Reduced out of pocket costs and expanded choice of providers for patients