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Ep. 6 Mike Trent: Beyond Self-Insured, Energizing Your Health Plan Funding with RBP
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Beyond Self-Funding: Why Reference-Based Pricing Is the Solution Hiding in Plain Sight
Mike Trent, VP of Business Development at ClaimDOC, reveals why self-funding alone doesn't solve healthcare costs—and how RBP can save employers $150,000 per 100 employees annually.
Vinny and Mike discuss reference-based pricing (RBP) as an alternative to traditional PPO networks for self-funded employers. Mike shares how his wife's $67,000 hospital bill became a $7,000 claim through RBP—with no balance billing to employees. They explore the reality that most self-funded employers still pay PPO prices (250% of Medicare) without realizing it, while RBP typically reimburses at 150% of Medicare.
The conversation covers balanced billing concerns (85% of hospitals accept RBP immediately), which employers are best suited for RBP, why CFOs need to lead healthcare financing decisions, and the skills gap among brokers. Mike emphasizes his mission to educate employers on all funding options, while Vinny announces plans for the Clear Benefits Academy launching in 2026.
Disclaimer: This content is for educational purposes only. Please discuss your specific situation with your health benefits administrator or insurance provider for personalized guidance.
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By Vinny CatalanoSend us a text
Beyond Self-Funding: Why Reference-Based Pricing Is the Solution Hiding in Plain Sight
Mike Trent, VP of Business Development at ClaimDOC, reveals why self-funding alone doesn't solve healthcare costs—and how RBP can save employers $150,000 per 100 employees annually.
Vinny and Mike discuss reference-based pricing (RBP) as an alternative to traditional PPO networks for self-funded employers. Mike shares how his wife's $67,000 hospital bill became a $7,000 claim through RBP—with no balance billing to employees. They explore the reality that most self-funded employers still pay PPO prices (250% of Medicare) without realizing it, while RBP typically reimburses at 150% of Medicare.
The conversation covers balanced billing concerns (85% of hospitals accept RBP immediately), which employers are best suited for RBP, why CFOs need to lead healthcare financing decisions, and the skills gap among brokers. Mike emphasizes his mission to educate employers on all funding options, while Vinny announces plans for the Clear Benefits Academy launching in 2026.
Disclaimer: This content is for educational purposes only. Please discuss your specific situation with your health benefits administrator or insurance provider for personalized guidance.