Some health insurers and plan administrators agree with patient groups: They say the government should develop consumer-protection rules for “reference pricing” — a hot health care cost-management tool.
Company representatives make that point in reference pricing comment letters sent to federal regulators. In May, the U.S. Department of Health and Human Services (HHS) joined with the Internal Revenue Service (IRS) and the Employee Benefits Security Administration (EBSA) to put out regulations letting employers use reference pricing in their health plans.
See also: Feds allow reference-based pricing
The regulators asked for comments on whether, and how, they should keep insurers and self-insured plan sponsors from abusing reference pricing.
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An insurer that uses reference pricing, which is also known as “reference-based pricing,” encourages or requires enrollees to use providers who accept a fixed payment for some or all services. A patient who uses a provider who charges more may have to pay some or all of the difference between the reference price and the actual price.
In some cases, an insurer may use reference pricing in place of a traditional managed care network. The insurer may pay the reference price to any medical provider who provides the service and let the patient cover the rest of the cost.
Justine Handelman writes in a letter for the Blue Cross and Blue Shield Association that some plans use reference pricing along with a provider network. In that case, Handelman says, the patient who sees a high-cost in-network provider pays the difference between the reference price and the usual in-network price.
Representatives for some insurers, insurance groups and employers asked regulators to go easy on plans that are experimenting with reference pricing.