Reference-Based Pricing

For providers that don't participate in the HealthSmart Physician and Ancillary Only or Prime Health Select networks, Sana will price claims using reference-based pricing (RBP).

In short, RBP sets a fair, fixed price for the medical care you receive. Our RBP is based on economical reimbursement levels designed to be fair and reasonable to providers, and therefore providers typically accept our RBP without issue.

Sana references Medicare and a variety of pricing data sets to determine our RBP.  Our typical RBP payment to physicians is 120% of what Medicare commonly pays and 140% for hospitals.

Note: Sana is NOT a Medicare plan. We simply reference their reimbursement rates to base our pricing on most facility and provider claims.

Benefits and Risks of Reference-Based Pricing

The primary benefit of RBP for Sana employers and members is lower premiums.

The primary risk is an increase in balance billing, which we see in 1-2% of all claims. Our team works hard to take care of balance bills when they come up, negotiating directly with the provider on your behalf.