Reference-Based Pricing (RBP) & general information
What makes Homestead’s health plans different from traditional PPO plans?
Homestead’s Reference-Based Pricing (RBP) plans eliminate inflated network markups by paying providers a fair, transparent rate based on Medicare and industry benchmarks—typically saving employers 25–30% compared to PPO plans.
What types of employers benefit most from Homestead’s solutions?
Our plans are ideal for mid-size employers (typically 50–1,000 employees) seeking to control healthcare costs without compromising employee care—especially in industries with skilled workers and hourly wages.
What kind of savings can employers expect?
Actual savings vary by employer, location, and utilization patterns. However, studies consistently show that commercial insurers often pay hospitals far more than Medicare – sometimes 170%-220% of Medicare rates. By anchoring payments to transparent benchmarks, many employers see meaningful, sustainable reductions in total healthcare spend.
Is RBP compliant with federal regulation?
Yes, RBP is a widely used and compliant reimbursement methodology when implemented correctly. Payments are based on data-driven benchmarks and plans are required to follow all applicable regulations, including ERISA and ACA requirements. A strong RBP partner ensures the methodology, communication, and member protections meet all regulatory standards.
Can fully insured employers move to RBP?
Yes, many fully insured groups begin exploring RBP because of rising premiums, limited transparency, and the desire for more control over their health plan costs. RBP is often considered as part of a transition to self-funding or level-funding. With proper onboarding, member education, and a thoughtful plan design, fully insured employers can successfully shift from a traditional network-based model to an RBP approach.
Does RBP impact the quality of care employees receive?
No, RBP only changes how a claim is priced and paid, not the care itself. Members can still choose any provider willing to accept the plan’s payment, and clinical decisions remain entirely between the patient and their doctor.
Member experience & provider access
Will employees still be able to choose their own doctors?
Yes, most RBP plans offer broad provider choice because they don’t rely on a contracted network. In most cases, our plans are open access and we help employees see the providers they choose by working directly with their providers before they seek care. Members can generally see any provider who is willing to accept the plan’s payment.
Is RBP the same as going “out-of-network”?
No, RBP does not use traditional “in-network” or “out-of-network” definitions. Payment is based on a benchmark, not a negotiated contract. Members are not penalized for choosing a provider of their choice since there are no network boundaries.
How do you help members find the right providers—or keep their current ones?
Members can submit a simple Provider Assistance Form for any doctor they want to see. Our team verifies acceptance, educates the provider, and performs outreach when needed. We also help identify RBP-friendly providers to avoid disruption.
What happens if a provider won’t accept the plan?
If a provider requests more than the plan’s allowed amount, your RBP partner steps in to communicate with the provider, explain the reimbursement methodology, and work toward a resolution. This is rare, but when a provider won’t accept the plan or negotiate a reasonable reimbursement, we’ll help guide employees to alternative, RBP-friendly providers—always with the employee’s care needs as the priority.
Do providers really understand RBP?
Many providers are familiar with Medicare-based methodologies, making RBP easier for them to understand. Clear, timely communication from the RBP partner also helps eliminate confusion and sets accurate expectations for payment.
Is RBP hard for employees to understand?
RBP is new to many people but with clear communication, simple educational materials, and a strong concierge support team, members quickly learn how it works. The most important thing for employees to know is that they’re supported.
Billing, claims, and support
How often do balance bills actually occur?
Balance bills can happen with any open-access plan, but they are not automatic or common. Less than 1% of all claims result in a balance bill. Strong RBP partners combine proactive provider communication, member education, and skilled advocacy, which significantly reduces the likelihood of balance bills and helps resolve issues quickly when they arise.
How do you prevent balance bills from becoming an issue?
We minimize balance bills through proactive provider engagement, expert negotiation, and fair, reasonable reimbursement combined with clear member education. When a balance bill does occur, our team handles the entire process through resolution—so the burden never falls on the employee or HR.
What happens if a member is confused about a bill or has trouble at the point of care?
One call to our on-shore Concierge Member Services team solves it. We explain the bill, contact the provider directly, and handle any issues so the member doesn’t have to. Our advocates stay with the case until it’s resolved.
Do employees contact Homestead directly?
Yes, our Concierge Member Services team handles all claims, billing, and provider questions.
How do members get help if they have a billing or claim issue?
Members contact our on-shore Concierge Member Services team—never an outsourced or generic call center. Our advocates are trained in RBP and benefits navigation, providing clear guidance on bills, coordinating care, and resolving questions directly with providers.
Who is BillingNav?
BillingNav is our partner in protecting health plans and participants from unfair medical charges. They provide expert advocacy, negotiation, and support for defending against balance bills, which includes, when needed, free legal representation by an independent law firm to defend against potential legal claims and collection efforts.
Can members be charged for any legal fees resulting from the balance bill process?
No, all legal services are provided free of charge until the billing dispute is resolved.
For employers: administration & implementation
Is it difficult to transition to a Reference-Based Pricing plan?
Not at all. Our implementation team provides a smooth onboarding process with clear communications, pre-launch education, and ongoing member support to ensure confidence and minimize disruption.
How do you minimize disruption when moving from a PPO plan to RBP?
Education and early engagement are key. By preparing employees weeks in advance, guiding provider verification, and ensuring every member understands how to use their ID card and where to go for help, transitions are smoother and provider issues are dramatically reduced.
How does Homestead simplify RBP for employees?
We deliver clear, plain-language member education, on-site or virtual training, personalized mailings, and ongoing engagement—so employees know what to expect and feel supported from day one.
How do you ensure employees understand how an RBP plan works?
We use a proven, multi-touch education process—live sessions, on-demand materials, direct mail, emails, and hands-on provider assistance—to prepare employees before day one. This reduces confusion, builds trust, and ensures confident use of the plan from the start.
How much work does this create for HR?
The key to a smooth transition is early engagement and proactive employee education. Homestead reduces HR’s burden and does the heavy lifting with member education, virtual and in-person education sessions, and high-touch, human support from experienced Client Managers and on-shore Member Concierge Services. With Homestead, HR isn’t left managing questions or provider issues.
How is Homestead’s TPA different from a traditional TPA?
Traditional TPAs are built around PPO networks and generic claims workflows. Homestead’s TPA is specifically designed for Reference-Based Pricing, with processes, member support, and provider outreach built to make RBP clearer, smoother, and more predictable for employers and members.
How is Homestead’s support model different from other RBP solutions?
Disconnected vendors create gaps in communication and service. Homestead’s integrated TPA, RBP, and Stop Loss model ensures that claims, repricing, member support, and provider advocacy work together for smoother operations and fewer HR escalations.
Can Homestead work with our existing benefits partners?
Yes. While many clients choose our fully integrated TPA, Stop Loss, and RBP solution, Homestead can also coordinate with your preferred TPA, PBM, or other vendors to fit your existing benefits structure.
What kind of reporting will I receive?
Employers and brokers receive clear, actionable reporting that highlights cost trends, RBP performance, utilization patterns, and opportunities to enhance plan outcomes. Reports are designed to be easy to understand—no confusing spreadsheets or black-box analysis.
Stop Loss & financial protection
Is stop loss required?
Yes, stop loss coverage is required for any self-funded health plan. Employers can choose Homestead’s integrated stop loss solution or bring their own stop loss partner to the table.
Can Homestead coordinate with any Stop Loss carrier?
Yes, while some clients choose integrated solutions, Homestead’s TPA works seamlessly with any Stop Loss carrier. We provide accurate, timely data and support carriers’ requirements to ensure smooth reimbursement and predictable plan performance.
Is your Stop-Loss coverage available as a stand-alone product, or only with the Claim Watcher plan?
Our Stop-Loss can be offered either integrated with the Claim Watcher plan for maximum alignment and savings, or as a stand-alone option for groups that want Homestead’s risk protection while using another TPA or plan design.
How does integrated Stop-Loss improve performance compared to traditional carriers?
Integrated Stop-Loss aligns incentives across repricing, claims administration, and risk management. With unified data and real-time insight into high-cost claims, employers often see more accurate projections, stronger savings, and faster reimbursement.
