Reference Based Pricing

Medical Helpline Advocate services are perfectly aligned to support members with Reference Based Pricing health plans. Our Advocates are available on an unlimited basis to assist patients with questions about their benefits, quality of providers and costs. The end result is improved health literacy for members, better health, and lower costs to the plan and the member.

Medical Helpline Advocates are integrated with our Utilization Management, Case Management and Quality of Care programs. We help educate members regarding the quality of providers and facilities and the amount the plan will pay providers. The Precertification program helps ensure that members understand their financial and health risks, while the Quality of Care program helps members find the highest rated providers and facilities at reasonable costs. Our Advocates will also assist patients in negotiating a fair price in advance of a scheduled procedure.