RBP Health Plans typically use a Medicare multiple to define the allowable payment amount, which is often significantly lower than provider billed charges. The disconnect between the plan’s allowable payment and the provider’s billed charges typically results in negotiations between the RBP vendor, like 6 Degrees, and the provider. When the parties cannot resolve the payment dispute, the member may be balance billed and the plan may be sued.
Self-funded plans are administered in coordination by a group of service providers. This includes TPAs, brokers and RBP vendors, each of which may have varying degrees of authority to resolve provider payment disputes. The cost-savings for RBP plans are no longer speculative, with average annual savings in excess of sixty percent (60%). The success of such programs, however, is largely dependent on the member experience, which can be impacted by the resolution of balance bills, member education and the coordination of services by TPA, brokers and RBP vendors. Our Fireside Chat will address strategies for successfully resolving balance bills and provider payment disputes for RBP plans and the role of service providers in the resolution process. Please join us for this highly anticipated discussion with industry experts.