Reference Based Pricing

Introduction

How much is the plan paying and how did they decide that amount?

Reference Based Pricing Map

What is the status of your local facility? Click on the linked map PDF below to find out.

Reference Based Pricing Frequently Asked Questions

What is Reference Based Pricing?

Reference Based Pricing is a method of paying hospitals and other medical facilities based on a standard reference point, in this case Medicare. Reference based pricing closes the gap in how much different hospitals in Montana charge for the same services and saves MMIA and our participants money.

Why use Medicare as a reference?

Medicare is the largest healthcare payer in the country. It gives us a relatively consistent way to compare facilities because all facilities accepting Medicare are measured in the same manner. Medicare’s calculation process is also publicly available.

Why did we move to a Medicare Reference Based Pricing program?

The cost of medical services continues to rise at a rate far faster than inflation of other goods/services and faster than employees’ pay. Reference based pricing is the most effective tool we have to bend that cost curve. This change will mean less money going to health care expenses and more going into employees’ pockets. It also creates a system that is more fair, transparent, comparable and predictable than how hospitals previously charged us.

How does Reference Based Pricing affect MMIA Plan Participants?

The good news is, every major hospital and almost every smaller hospital in Montana have signed Reference Based Pricing contracts for the MMIA Plan. That means your benefits will function exactly as they do now. You pay your deductible and coinsurance and the Plan pays a fair amount based on a market analysis on your behalf. You may actually see slightly lower out-of-pocket costs for some services at some facilities.

What if I go outside the state of Montana?

Services outside the state of Montana will be subject to the Cigna network. Visit www.askallegiance.com/MMIA to see a list of Cigna in-network providers and facilities.