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When employers consider a referenced-based pricing (RBP) plan, one concern comes up repeatedly: Will my employees be able to see their providers?

It’s a fair question, and one that often reflects broader uncertainty about access and potential disruption.

At Homestead, we believe access shouldn’t be left to chance. That’s why our open access plans include convenient access to more than 700,000 physicians, specialists and ancillary providers through Prime Health Services’ Physician Only Network (PON).

We also help members see the providers they choose through our Clear the Path program, a proactive approach to provider relations designed to remove barriers before members ever need care.

 

What “Clearing the Path” Actually Means

Clear the Path isn’t reactive. It doesn’t start when a claim is denied or a member is frustrated. Clear the Path is proactive and starts before the plan goes live.

Our Provider Relations team uses historical claims data to identify the providers members already rely on most. We proactively confirm continued access well in advance of the plan’s effective date, allowing potential issues to be identified and resolved early.

This approach is a key reason Homestead consistently achieves a 98% provider acceptance rate.

 

 

How Proactive Provider Outreach Works

Here’s what happens behind the scenes:

  • Claims history helps us identify the providers most important to members
  • Providers are then grouped based on whether they already participate in Prime’s national network
  • For providers outside the network, we then check whether Homestead has prior experience working with them
  • If a provider is outside the network and we have limited or no prior experience, our team reaches out directly to explain the plan and confirm how claims will be submitted
  • Our team explains the reimbursement approach and confirms the provider’s willingness to accept the plan.
  • Once outreach is complete, we communicate back to the employer, and support member communication as needed, so they know the path has been cleared prior to the effective date.

Providers aren’t asked to “figure it out”, they are supported through clear communication.

 

Questions Brokers & Employers Hear Most

Clear the Path exists because we understand the concerns and we’ve built the process to answer them directly.

Q: What if a large hospital says they don’t accept RBP?

Provider acceptance is rarely a binary yes or no. Our team engages in education, clarifies reimbursement expectations, and explores solutions such as prior experience, alternative facilities, or targeted agreements when appropriate.

Q: What happens if a provider doesn’t accept the first payment?

If questions arise after care is delivered, our team steps in to manage communication, address concerns, and protect the member from disruption.

Q: How do you mitigate balance billing risk?

In the off chance a balance bill happens, Homestead handles outreach, negotiation, and resolution. Members are never left to handle the situation on their own.

Q: Can you do direct contracting if needed?

Yes. In certain circumstances, contracting with anchor facilities can be an option when it supports access and member needs in a specific market.

 

Why Provider Relations Is the Linchpin of RBP Success

Reference-based pricing works when provider relations are strong. Clear the Path connects strategy to execution, ensuring that pricing models are supported by real conversations, real outreach, and real follow-through. It’s the difference between a plan that looks good on paper and one that works in practice.

 

For brokers, this means confidence in addressing objections.

For employers, it means reassurance that access remains intact.

For members, it means fewer barriers to care.

 

 

Our Clients Succeed

“When I have a question, I get an answer-timely! They are there for me and my employees. I feel they always go above and beyond for us!”
Phil McClay
Director of Human Resources
ALL Holding Company, LLC
“We were able to reinvest in our equipment for the first time in years with the money we saved using Claim Watcher and Reference Based Pricing!”
Harold Kropp
CFO
Wirerope Works, Inc.
“Installation was seamless. My client didn’t have to do much, it was effortless. The education provided to the employee was easy for them to understand and impeccable customer service.“
Nicholas F. Castellano
President and CEO
Castle Benefits Consulting Group

Get in touch

It’s our privilege to answer any questions that you might have about our services. Thank you for contacting Homestead Smart Health Plans.
CONTACT US
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The Consolidated Appropriations Act of 2021 (CAA 2021) opened the door to class action lawsuits against employer-sponsored health plans in several ways. Most notably by expanding fiduciary obligations, increasing required disclosures, and creating a paper trail that plaintiffs can exploit.

Now, the recent surge in lawsuits focusing on ERISA fiduciary obligations is proving that plan sponsors concerned about their litigation risk had right to be worried.

Plan participants and plaintiff firms are increasingly alleging that employers:

  • Overpaid for healthcare services by not properly evaluating vendor pricing
  • Breached fiduciary duties by ignoring conflicts of interest
  • Failed to act prudently in selecting or monitoring PBMs or other vendors

The most significant example so far is the Johnson & Johnson (J&J) lawsuit. Originally filed in February 2024, this new and novel legal case argues the company failed their “duty of prudence” when selecting a pharmacy benefits manager (PBM) and negotiating drug pricing.

Lewandowski v. Johnson & Johnson: A Wake-Up Call for Health Plan Fiduciaries

Overview: This class action lawsuit filed by a J & J employee principally involves mismanagement of prescription-drug benefits. The lawsuit claims J & J breached their fiduciary duties by failing to prudently select a pharmacy benefit manager (PBM) and by mismanaging J & J’s prescription-drug benefits program by failing to negotiate favorable pricing.

In a noteworthy move, the lawsuit also seeks to hold specific individuals within Johnson & Johnson personally liable as fiduciaries, including several HR executives and 20 members of the Pension & Benefits Committee.

Lawsuit Status as of Aug 1, 2025:

The initial complaint was dismissed earlier this year for lack of standing. An amended complaint is currently under court review.

Implications for Self-Funded Plan Sponsors

The case marks one of the first major legal tests of how ERISA fiduciary rules apply to health plans post–Consolidated Appropriations Act of 2021. It also signals a new era of litigation risk for employers who don’t actively manage vendor performance and pricing transparency.

While the case is ongoing, it’s a clear reminder and warning for employers.

Fiduciary responsibilities extend to vendor management and cost oversight—especially around pharmacy benefits. Employers should review all their fiduciary obligations and maintain robust fiduciary procedures.

The lawsuit claims also underscore how important it is for employers to obtain clear and complete compensation disclosures from all service providers to understand any potential conflicts of interest

Fiduciaries and Their Duties Under ERISA

A fundamental issue is that many companies don’t know or misinterpret who exactly holds fiduciary responsibilities, and what those obligations mean.

Per the U.S. Department of Labor, fiduciaries are those persons or entities with discretionary control or authority over plan management or assets, and/or responsibility for plan administration.

Their responsibilities and duties include:

  • Acting solely in the interest of plan participants for the exclusive purpose of providing benefits and paying plan expenses
  • Prudently managing plan functions or hiring experts who can
  • Following the terms of their ERISA-compliant plan document
  • Avoiding conflicts of interest
  • Not engaging in self-dealing or transactions that benefit parties related to other fiduciaries, service providers, or the plan sponsor.

 

The Significance of “Acting Prudently” as a Fiduciary

Acting prudently is the primary responsibility of fiduciaries under ERISA, requiring specialized knowledge and expertise. So first and foremost, employers who lack this internal expertise must engage qualified professionals and document their rationale for doing so. Other key practices:

  • Keep the plan document up to date
  • Ensure operations align with the plan’s terms
  • Document decisions that impact the plan or its participants

 

Homestead’s Role as a Claims Fiduciary

As a third-party administrator, Homestead serves as the claims fiduciary authorized to make decisions on claim processing and payment.

Our fiduciary duty is limited to claims-related actions. We do not share the full fiduciary obligations of the employer or plan sponsor but are legally required to:

  • Act in participants’ best interests
  • Follow the plan document
  • Administer claims fairly and prudently

Steps and Support to Reduce Your Risk

To minimize litigation risk, we recommend the following actions and can provide additional information and guidance if you need help getting started or have questions.

  • Evaluate and monitor vendors to avoid real or perceived conflicts of interest
  • Review plan designs regularly and document rationale for changes to cost-sharing or design.
  • Keep plan documents current, amend as needed, and follow ERISA rules for participant communication
  • Ensure timely compliance by filing required forms like the 5500 promptly
  • Train decision-makers and educate employees on ERISA fiduciary duties
  • Document all decisions, especially those that impact costs or participant benefits
  • When in doubt—ask. Consult with your broker or Homestead contact about fiduciary questions

 

Count on Homestead as Your Fiduciary Compliance Partner

Navigating fiduciary obligations under ERISA is complex and the stakes are high. Contact us to learn more.

 

 

 

 

Our Clients Succeed

“When I have a question, I get an answer-timely! They are there for me and my employees. I feel they always go above and beyond for us!”
Phil McClay
Director of Human Resources
ALL Holding Company, LLC
“We were able to reinvest in our equipment for the first time in years with the money we saved using Claim Watcher and Reference Based Pricing!”
Harold Kropp
CFO
Wirerope Works, Inc.
“Installation was seamless. My client didn’t have to do much, it was effortless. The education provided to the employee was easy for them to understand and impeccable customer service.“
Nicholas F. Castellano
President and CEO
Castle Benefits Consulting Group

Get in touch

It’s our privilege to answer any questions that you might have about our services. Thank you for contacting Homestead Smart Health Plans.
CONTACT US
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Our Clients Succeed

“When I have a question, I get an answer-timely! They are there for me and my employees. I feel they always go above and beyond for us!”
Phil McClay
Director of Human Resources
ALL Holding Company, LLC
“We were able to reinvest in our equipment for the first time in years with the money we saved using Claim Watcher and Reference Based Pricing!”
Harold Kropp
CFO
Wirerope Works, Inc.
“Installation was seamless. My client didn’t have to do much, it was effortless. The education provided to the employee was easy for them to understand and impeccable customer service.“
Nicholas F. Castellano
President and CEO
Castle Benefits Consulting Group

Get in touch

It’s our privilege to answer any questions that you might have about our services. Thank you for contacting Homestead Smart Health Plans.
CONTACT US
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Innovation. Transparency. Partnership. And an enhanced member experience. Find out what makes Homestead the fastest-growing reference-based pricing solution on the market.

Watch Video

Our Clients Succeed

“When I have a question, I get an answer-timely! They are there for me and my employees. I feel they always go above and beyond for us!”
Phil McClay
Director of Human Resources
ALL Holding Company, LLC
“We were able to reinvest in our equipment for the first time in years with the money we saved using Claim Watcher and Reference Based Pricing!”
Harold Kropp
CFO
Wirerope Works, Inc.
“Installation was seamless. My client didn’t have to do much, it was effortless. The education provided to the employee was easy for them to understand and impeccable customer service.“
Nicholas F. Castellano
President and CEO
Castle Benefits Consulting Group

Get in touch

It’s our privilege to answer any questions that you might have about our services. Thank you for contacting Homestead Smart Health Plans.
CONTACT US
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At Homestead, our mission is to create transparent and sustainable health plans and put the power back in the hands of the employer. Homestead Smart Health Plans was formed by health insurance industry insiders from some of the biggest names in the business to solve the core problem of rising costs and decreasing coverage.

Watch Video

Our Clients Succeed

“When I have a question, I get an answer-timely! They are there for me and my employees. I feel they always go above and beyond for us!”
Phil McClay
Director of Human Resources
ALL Holding Company, LLC
“We were able to reinvest in our equipment for the first time in years with the money we saved using Claim Watcher and Reference Based Pricing!”
Harold Kropp
CFO
Wirerope Works, Inc.
“Installation was seamless. My client didn’t have to do much, it was effortless. The education provided to the employee was easy for them to understand and impeccable customer service.“
Nicholas F. Castellano
President and CEO
Castle Benefits Consulting Group

Get in touch

It’s our privilege to answer any questions that you might have about our services. Thank you for contacting Homestead Smart Health Plans.
CONTACT US
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Here is how Homestead members are protected against surprise balance bills.

Watch Video

Our Clients Succeed

“When I have a question, I get an answer-timely! They are there for me and my employees. I feel they always go above and beyond for us!”
Phil McClay
Director of Human Resources
ALL Holding Company, LLC
“We were able to reinvest in our equipment for the first time in years with the money we saved using Claim Watcher and Reference Based Pricing!”
Harold Kropp
CFO
Wirerope Works, Inc.
“Installation was seamless. My client didn’t have to do much, it was effortless. The education provided to the employee was easy for them to understand and impeccable customer service.“
Nicholas F. Castellano
President and CEO
Castle Benefits Consulting Group

Get in touch

It’s our privilege to answer any questions that you might have about our services. Thank you for contacting Homestead Smart Health Plans.
CONTACT US
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Welcome to Homestead Smart Health Plans, an innovative way to save you money that’s easy to use, let us show you how…

Watch Video

Our Clients Succeed

“When I have a question, I get an answer-timely! They are there for me and my employees. I feel they always go above and beyond for us!”
Phil McClay
Director of Human Resources
ALL Holding Company, LLC
“We were able to reinvest in our equipment for the first time in years with the money we saved using Claim Watcher and Reference Based Pricing!”
Harold Kropp
CFO
Wirerope Works, Inc.
“Installation was seamless. My client didn’t have to do much, it was effortless. The education provided to the employee was easy for them to understand and impeccable customer service.“
Nicholas F. Castellano
President and CEO
Castle Benefits Consulting Group

Get in touch

It’s our privilege to answer any questions that you might have about our services. Thank you for contacting Homestead Smart Health Plans.
CONTACT US
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By using the Homestead Smart Health Plans reference-based pricing solution, you could save 25% or more on the cost of your health care plan.

Watch Video

Our Clients Succeed

“When I have a question, I get an answer-timely! They are there for me and my employees. I feel they always go above and beyond for us!”
Phil McClay
Director of Human Resources
ALL Holding Company, LLC
“We were able to reinvest in our equipment for the first time in years with the money we saved using Claim Watcher and Reference Based Pricing!”
Harold Kropp
CFO
Wirerope Works, Inc.
“Installation was seamless. My client didn’t have to do much, it was effortless. The education provided to the employee was easy for them to understand and impeccable customer service.“
Nicholas F. Castellano
President and CEO
Castle Benefits Consulting Group

Get in touch

It’s our privilege to answer any questions that you might have about our services. Thank you for contacting Homestead Smart Health Plans.
CONTACT US
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Rising health benefit costs threaten to bankrupt the company.

Wirerope Works, Inc. faced an uncertain future because escalating benefits costs and foreign competition threatened the company’s financial health. Although years ago, management had decided to implement a self-funded managed care program because they believed they could reduce costs, the company continued to face yearly increases.

Read Our Full Case Study

Our Clients Succeed

“When I have a question, I get an answer-timely! They are there for me and my employees. I feel they always go above and beyond for us!”
Phil McClay
Director of Human Resources
ALL Holding Company, LLC
“We were able to reinvest in our equipment for the first time in years with the money we saved using Claim Watcher and Reference Based Pricing!”
Harold Kropp
CFO
Wirerope Works, Inc.
“Installation was seamless. My client didn’t have to do much, it was effortless. The education provided to the employee was easy for them to understand and impeccable customer service.“
Nicholas F. Castellano
President and CEO
Castle Benefits Consulting Group

Get in touch

It’s our privilege to answer any questions that you might have about our services. Thank you for contacting Homestead Smart Health Plans.
CONTACT US
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Another successful Broker Connect and Whiskey Tasting is in the books! Shoutout to Senior Vice President of Sales, Bruce Buchanan, for leading this event, selecting such a great venue, and sharing Homestead’s mission to partner with you in finding the best healthcare at the lowest costs.

Thank you to all who came out and shared a wonderful time with us!

Our Clients Succeed

“When I have a question, I get an answer-timely! They are there for me and my employees. I feel they always go above and beyond for us!”
Phil McClay
Director of Human Resources
ALL Holding Company, LLC
“We were able to reinvest in our equipment for the first time in years with the money we saved using Claim Watcher and Reference Based Pricing!”
Harold Kropp
CFO
Wirerope Works, Inc.
“Installation was seamless. My client didn’t have to do much, it was effortless. The education provided to the employee was easy for them to understand and impeccable customer service.“
Nicholas F. Castellano
President and CEO
Castle Benefits Consulting Group

Get in touch

It’s our privilege to answer any questions that you might have about our services. Thank you for contacting Homestead Smart Health Plans.
CONTACT US