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Reference Based Pricing

What is Reference Based Pricing?

Reference Based Pricing (RBP) is the amount of money your health plan has determined it will pay for specific medical services. A reference price is often used to ensure that payments to providers are reasonable.

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Examples of Reference Prices Include:

  • Free Market Price, such as KPPFree™, online retailer, or another market price option.
  • Healthcare Bluebook Fair price.
  • A percentage above the amount paid to the provider by Medicare

Many benefit plans utilize RBP for out-of-network benefits, or as a replacement for a PPO network. If you have questions about your RBP benefits, please Contact Us.

How do you know if your plan is contracted with a network?

To determine whether your plan has contracted with a PPO network, review the Medical Plan section of your ID card, log in to our Secure Benefit Portal, or contact us.