Generating Significant Savings through Reference-Based Pricing Navigation

The Challenge

Following a wrist injury, a plan member was recommended for surgery by an in-network orthopedic provider. The surgeon initially scheduled the procedure at a facility that did not accept reference-based pricing (RBP). The facility initially quoted $90,000 for the procedure, later offering a 50% discount for $45,000.

Our Solution

OneVeracity's Care Solutions team identified the challenge during the pre-certification process and proactively engaged with the provider before the procedure was performed.

Working directly with the provider's office, the team:

• Confirmed the procedure as medically necessary
• Coordinated with the provider to move the procedure to an RBP-friendly surgery center
• Ensured the member received the same medically appropriate care while avoiding unnecessary healthcare spending for the plan

The proactive navigation by OneVeracity's RBP Navigator prevented the surgery from being performed at a significantly higher-cost facility, all while maintaining continuity of care for the member.

Our Impact

Our RBP Navigator program allows employers to control healthcare costs without compromising care for their members.

• Successful redirection to an RBP-friendly facility
• Maintained timely access to medically necessary care
• $42,321 total cost savings for the employer
• $13,894 total billed
• $2,678 repriced final claim

OneVeracity's RBP Navigator program helps members confidently navigate reference-based pricing by proactively coordinating with providers and advocating for member care. The result is lower healthcare costs, fewer billing challenges, and a better experience for both employers and employees.

Ready to adopt reference-based pricing? Let's connect.