REFERENCE BASED PRICING

Contain costs without sacrificing quality.

Take control of rising medical expenses with a proven payment model.

We know
what works.

The cost of medical care often goes unchecked and there’s no consistency between doctors, hospitals, or procedures. Despite what we’ve been led to believe, just because we pay more doesn’t necessarily mean it’s better care.

And when pricing varies so greatly, it’s difficult to plan for future medical expenses. But what if there was a payment model that could deliver cost savings, more accurate pricing predictability, and higher quality care?

That’s just what our reference based pricing plan offers.

Hand-selected providers who favor quality over dollars.

Reference based pricing directly addresses the major issues that drive up medical costs — the provider’s financial arrangements.

It exchanges a traditional provider network payment model for a financial arrangement based on agreed-upon reimbursement rates like those used by Medicare.

When combined with care advocacy, reference based pricing drives better quality and cost containment through a carefully curated network of providers who know how to provide high-value healthcare.

Reinvest in your business.

Our reference based pricing isn’t complicated or risky. In fact, it’s an effective tactic used by self-insured employers that want to ensure the highest value care possible.

With the money saved, you can reinvest in your team and your business.

  • As much as a 30% reduction in medical spending through more reasonable, negotiated rates
  • Better cost predictability by eliminating price variation across doctors, hospitals, and procedures
  • Lower out-of-pocket medical costs for members

Reference Based Pricing Services

Continuity of Care

During the transition to our program, members won’t experience any disruptions in care.

We pre-approve specialists and imaging services that have already been scheduled.

Claims Repricing

We reprice claims or will work with your third-party vendor.

Regardless of who does claims adjudication, our team audits payments on a monthly basis and discusses the results with you, your TPA, and your benefits advisor.

Direct Pay

We proactively negotiate payments to physicians and facilities at or before the time of service.

It’s an efficient way of paying providers that saves money and eliminates any balance billing issues.

Balance Bill Management

If a member experience issues with balance billing, our team will advocate on the member’s behalf to resolve the balance bill, ensuring there are no excessive charges.

SentryHealth has been the gateway to lower healthcare costs the last three years. Our results speak for themselves, each year benefits have gotten richer, and costs have gone down.

– Laurie M., Benefits Consultant