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Medical Pricepoint - About Us

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Our mission is to enable individuals to make fully informed decisions concerning their health care options.

Who We Are

The primary problem with the runaway cost for health care is the complete lack of any control. The cost for delivering any product or service within the U.S. health care system is now completely unknown. Pricing is now either imposed by a government for entitlement programs or, in the private sector, pricing is established in an opaque setting by negotiations between providers of medical services and insurance companies. What no now knows is the true dynamic market price for those services.

Medical Pricepoint brings the real pricing numbers to the patient and to the employer that has a health plan benefit. Our technology determines the actual cost, both fixed and variable, for delivering any service and researches what an individual provider is currently accepting for payment. Based upon this information, Medical Pricepoint determines the fair reference price it uses for its “Reference Based Reimbursement” (RBR) service which includes a reasonable margin for the service provider. This is the only data analysis approach that is currently accepted as valid by both federal and state courts across the country. It is now the “gold standard” for repricing medical claims.

In addition, Medical Pricepoint offers, on an elective basis, access to a vibrant alternative cash payment based pricing market to its clients. This is the currently available pricing structure that is only available to individuals with the means to pay for services in cash at the time of service. This market bundles all the products and services in an episode of care rather than the current a la cart structure and sets a fixed and guaranteed price for the bundle. It serves the elective, or scheduled, services, not for emergency service, market. The pricing for these bundled price services is now well below what is currently paid under Medicare.

By combining repricing medical claims and adding the option of bundled service pricing, Medical Pricepoint delivers reductions in cost to the patient and the employer of between 25% and 45% of current insurance company pricing for those same services depending on the specifics of the individual case and the provider delivering the service. Furthermore, Medical Pricepoint sets up a competitive framework for ongoing dynamic pricing using provider bidding for each individual service opportunity that is designed to change in real time just as is the case for the rest of America’s markets.

Medical Pricepoint sets up the market pricing framework and then manages the process in behalf of the patient, so they are not exposed to financial liability by provider balance bill for either emergency or elective services.