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Transparency Brings Down Medical Costs

There are many ways that transparency pricing brings down medical costs for patients, as well as insurance companies. The three we are going to delve into here include; MBA’s OpenSolutions™ Platform, invoice auditing and reference pricing.

OpenSolutions™ Platform

MBA Benefit Administrators helps companies save hundreds of thousands of dollars in expenditures annually by taking a multi-layered approach to repricing, including the following strategies;

  • The use of repricing specialists for Medicare Plus and Cost Plus repricing solutions.
  • Deepest discount PPO repricing, along with one or more secondary PPO options, as well as claims discount negotiators squeeze every last discount out before the claim is considered for payment.
  • Secondary PPO contracts are set up on a percent of savings and paid once discounts are achieved.
  • An auto-routing function which allows the established repricer layering structure to be set up with the primary repricer and secondary PPO networks.
  • If the PPO concept is chosen by the client, and discounts are not available under the specified PPO listing, MBA sends the claim to discount negotiating specialists to obtain a discount for you.

Invoice Auditing

Having a checks and balance system to audit medical invoices is a must. “Ninety-nine percent of hospital bills are paid without what any rational individual would consider reasonable documentation of the hospital’s charges,” according to Mike Dendy, the chief executive of Advanced Medical Pricing Solutions, or AMPS, an Atlanta company that reviews and renegotiates hospital bills.

At MBA, we work along side ELAP, a leader in fiduciary protection, to provide CostPlus, a cutting edge healthcare solution for employers which provides transparency, protection and accountability for medical providers and members. Together, we shield our members from inflated costs by auditing claims riddled with exorbitant charges from healthcare facilities, and to provide legal defense if balance billing or a collection attempt occurs.

Times author, Rosenberg describes, “Auditing bills isn’t difficult. Medicare does it. It has recovered hundreds of millions of dollars by catching practices like double billing. And the fear of audits has no doubt reduced Medicare fraud in general.”

Reference Pricing

Having reference pricing opens up the free market system and puts consumers back in control of care options and costs, especially in services that are planned.


Reference Pricing Lowers the Cost of Knee Replacement Surgery

The California Public Employees’ Retirement System, otherwise known as CalPERS is an industry innovator when it comes to reference pricing. In the state of California, a hip replacement costs anywhere from $15,000-$110,000. 46 hospitals agreed with CalPERS to perform the operation for $30,000.

CalPERS told members that they would only pay up to that $30k threshold. They could go wherever they chose to have the procedure done, but it would be their responsibility to cover the balance if they went outside of the hospitals where the price was solidified.

Amazing things began to happen! Consumers began to price shop hospitals. Because of the new “compete or lose out” mentality for the providers, 40 additional hospitals offered the hip replacement surgery for the set price of $30,000. Not only have overall costs dropped significantly for the provider, while maintaining a high level of care, but the success of the methodology has opened up the opportunity for CalPERS’ insurance company to expand reference pricing to other procedures as well.

Transforming the medical industry to create more affordable care will not come with just one solution. However, encouraging transparency in cost, and creating systems that mandate accountability and problem-solving will inspire medical providers, insurance companies and administrators to create products and services that are safe and innovative while also being competitive in price. This will give consumers more options, to receive less expensive, high quality care.

For more information about this article, or to learn about how your company could benefit from switching to a self-insured plan, please contact our office at  800-877-3727 or email us at sales@

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