Review Policy on Unique Plan Design and “Set Your Own Price” Services

The Alliance adopted a formal policy last year barring any activity by members that impairs our ability to effectively contract with providers on behalf of the membership.

This includes, but is not limited to, implementation of benefit plan designs that override Alliance negotiated rates and other contract terms. The Alliance Board has identified the following concerns with “set your own price” services:

• They violate our contracts with hospitals and clinicians, which include negotiated rates that are expected to apply to all services outside of QualityPath.
• They undermine our relationships with hospitals and clinicians by appearing to indicate that we are not negotiating in good faith and/or are not negotiating on behalf of all members.
• They place patients at financial risk. Before receiving health care services, patients using these services are unable to obtain estimates of their out-of-pocket costs; afterward, patients are caught up in the billing cycle while the vendor and hospital engage in negotiations that may take months or even years. In the meantime, patients are stuck in the middle and can be sent to collections, risking their credit rating and exposing them to possible legal fees.

Please familiarize yourself with this policy here and contact our Member Services or Business Development staff with any questions.

The Alliance’s greatest strength is our members’ ability to work together to achieve common objectives, with controlling cost as our #1 goal. Our most important asset for controlling cost is our network of providers, which is much more than a collection of negotiated contracts. Our network represents relationships and commitments between hospitals, clinicians and each member of The Alliance.

Learn more about the background for this policy from The Alliance president & CEO, Cheryl DeMars in our 2015 October Newsletter.