[[CLAIM DATA: replace with verified anonymized example]]
- Arthroscopic knee repairBilled$48,210ESC100 priced$9,180
- MRI, lower extremityBilled$4,860ESC100 priced$712
- Inpatient, 2 daysBilled$31,400ESC100 priced$7,940
The bill is not the price.
ESC100 prices each claim against a defensible benchmark instead of the hospital chargemaster, then defends that price on the member’s behalf if it is challenged.
How the plan works
Three steps, in this order
Reference-based pricing is a sequence, not a product. Each step depends on the one before it.
- 01
The claim arrives
A provider submits billed charges. Eligibility and plan terms are verified the same day the claim lands, so nothing sits in a queue waiting on a file transfer.
- 02
It is priced against a benchmark
Reference-based pricing sets the allowed amount from a published, auditable cost basis rather than the chargemaster. Plans with a dual-network option keep contracted rates where those rates are already reasonable, and use the benchmark everywhere else.
- 03
The price is defended
If a provider disputes the allowed amount, ESC100 handles the dispute — documentation, negotiation, and, where warranted, legal support. The member is not the one arguing.
Who we serve
Built for whoever holds the risk
Employers
You carry the claims risk. You need cost control that does not turn into a benefits complaint every open enrollment. RBP with an administrator who answers the phone.
Brokers and advisors
Your name is on the recommendation. Reporting your client can read, service that responds, and pricing decisions you can explain in a renewal meeting.
Public entities and pools
School districts, municipalities, and interlocal pools. Procurement-grade documentation, transparent pricing methodology, and reporting suitable for a public board packet.
Member protection
If a provider bills the member for the difference, we take it
Balance billing is the thing members are afraid of, and the fear is reasonable. A claim is paid at the benchmark, the provider sends a bill for the remainder, and an employee who did nothing wrong is holding a number with too many digits.
The member calls the number on the card. ESC100 opens the case, contacts the provider, supplies the pricing documentation, and works the dispute to resolution. Members are told, plainly and in advance, not to pay a balance bill and to send it to us instead.
We do not promise a specific outcome on every claim. We do commit that the member is never the one negotiating. [[STAT: share of balance bills resolved without member payment]]
Data and reporting
You should be able to see the plan you are paying for
Timely claims data
Paid and pended claims available on a current cycle, not a quarter behind. Member-level detail where the plan permits it.
Standard reporting
Monthly plan performance, large-claim tracking, network utilization, and a renewal package your broker can hand to a board.
Predictive analytics
Risk scoring on the population to flag developing high-cost claimants early enough for care management to matter.
Care management
Nurse-led outreach on complex cases, coordination with the plan's clinical partners, and steerage to quality providers.
Request a plan review.
Send your current plan documents and claims experience. We will price a representative sample against our benchmark and walk you through what we find.