Reference-Based Pricing (RBP): How It Works
For providers who are not directly contracted with Sana Benefits or in the HealthSmart Physician & Ancillary only network, Sana uses reference-based pricing (RBP) to price claims.
What is RBP?
RBP establishes a fair, fixed price for medical care. It is based on economical reimbursement levels designed to be reasonable for providers, and most providers accept RBP without issue.
How Sana Calculates RBP
We reference Medicare rates and other industry pricing data to determine RBP. Typically, Sana pays:
- Physicians: 120% of what Medicare commonly pays
- Hospitals: 140% of what Medicare commonly pays
Note: Sana is NOT a Medicare plan. We simply use Medicare reimbursement rates as a reference point to calculate pricing for most facility and provider claims.
Benefits and Risks of Reference-Based Pricing (RBP)
Benefits:
- Lower Premiums: RBP helps employers and members save money by reducing healthcare costs.
Risks:
- Balance Billing: In rare cases (1–2% of claims), providers may issue a balance bill for the difference between their charges and the RBP amount. If this happens, our team works directly with the provider to resolve the issue, negotiating on your behalf.
Have Questions? We’re Here to Help.
- Log in to view account details.
- Search FAQs in our Help Center.
Connect with Customer Support directly through the chat icon on most Sana pages or call us at (833) 726-2123 Monday through Friday, 7 AM to 7 PM Central.