# Reference-Based Pricing, Part 2: What Employees Experience. Danielle Young of ClaimDoc.

Source: https://ethosbenefits.com/podcast/reference-based-pricing-employees-danielle-young
Type: Podcast episode
Series: The Business of Benefits, Episode 56
Published: 2025-07-24
Duration: PT34M21S
Hosts: Chelsea Ryckis, Founder and President, Ethos Benefits
Guests: Danielle Young, ClaimDoc
Video: https://www.youtube.com/watch?v=MFXg2pauaw8
Publisher: Ethos Benefits
Cite as: "Reference-Based Pricing, Part 2: What Employees Experience. Danielle Young of ClaimDoc.," The Business of Benefits, Episode 56, Ethos Benefits, https://ethosbenefits.com/podcast/reference-based-pricing-employees-danielle-young, 2025-07-24.

**Summary:** Employers moving to reference-based pricing usually hear two fears from employees: my doctor won't take it, and I'll get a balance bill. In Part 2 of her conversation with Chelsea Ryckis of Ethos Benefits, Danielle Young of ClaimDoc explains how provider acceptance and balance bills work in practice, why some brokers sell against reference-based pricing, and how to communicate the plan to employees all year.

## Key takeaways

- Danielle Young says ClaimDoc has 96.4% provider acceptance nationally, and that over 96% of the more than 24,000 providers its members nominated last year agreed to accept the plan.
- Chelsea Ryckis recommends rolling out reference-based pricing before open enrollment so employees can name their providers ahead of time, and Young says ClaimDoc starts that outreach 60 days before the effective date, beginning with members who have appointments booked.
- Young says balance bills already happen on about 8% of claims on major carrier plans, and that ClaimDoc's balance bill rate is less than 1% nationally.
- Young says ClaimDoc contacts the provider after the first balance bill it learns about and works with state attorneys general to reverse credit impairments, which is why employees need to open their mail and report bills.
- Young says an employer whose broker dismisses reference-based pricing without experience to back it up should challenge that broker and interview others.
- Young recommends starting employee communication no less than 60 days before the plan year and continuing it at least quarterly, and Chelsea Ryckis describes Ethos Benefits sending two targeted text messages a month that spouses and dependents can opt into.

## Chapters

- 00:01 Part 2: the employee experience of reference-based pricing (https://www.youtube.com/watch?v=MFXg2pauaw8&t=1s)
- 00:57 My doctor doesn't take this: provider acceptance rates (https://www.youtube.com/watch?v=MFXg2pauaw8&t=57s)
- 04:10 Aggressive vs fair reimbursement: driving in the middle (https://www.youtube.com/watch?v=MFXg2pauaw8&t=250s)
- 05:05 Why to roll out reference-based pricing before open enrollment (https://www.youtube.com/watch?v=MFXg2pauaw8&t=305s)
- 06:31 The pave the way process and provider outreach (https://www.youtube.com/watch?v=MFXg2pauaw8&t=391s)
- 08:20 What a balance bill is and how it works (https://www.youtube.com/watch?v=MFXg2pauaw8&t=500s)
- 09:16 Balance billing on carrier plans vs reference-based pricing (https://www.youtube.com/watch?v=MFXg2pauaw8&t=556s)
- 13:00 What a co-fiduciary vendor means for employers (https://www.youtube.com/watch?v=MFXg2pauaw8&t=780s)
- 14:56 When your broker pushes back on reference-based pricing (https://www.youtube.com/watch?v=MFXg2pauaw8&t=896s)
- 20:37 Why many brokers still sell against reference-based pricing (https://www.youtube.com/watch?v=MFXg2pauaw8&t=1237s)
- 24:20 Ongoing employee communication for a reference-based pricing plan (https://www.youtube.com/watch?v=MFXg2pauaw8&t=1460s)
- 26:40 Targeted text campaigns that reach spouses and dependents (https://www.youtube.com/watch?v=MFXg2pauaw8&t=1600s)

## Quotes

> Nationally, our balance bill rate right now is less than 1%.

Danielle Young, ClaimDoc

> The most important thing is to do it right the first time.

Danielle Young, ClaimDoc

> Remember, employers, what Danielle just said: you have all the control.

Chelsea Ryckis, Ethos Benefits

## In this episode.

Employers considering reference-based pricing tend to hear the same objections from employees and brokers: doctors won't accept it, and members will get balance bills. In this episode of The Business of Benefits from Ethos Benefits, Chelsea Ryckis and Danielle Young of ClaimDoc move from how [reference-based pricing](https://ethosbenefits.com/benefits-101/reference-based-pricing) works to what employees actually experience on the plan. It continues their conversation from [Part 1 with Danielle Young](https://ethosbenefits.com/podcast/reference-based-pricing-danielle-young).

Young walks through ClaimDoc's provider outreach, how it responds when a balance bill arrives, and why she calls balance billing fears a scare tactic. The figures on acceptance and balance bill rates are her own, for ClaimDoc's book of business. Ryckis closes with the communication plan Ethos Benefits uses to keep employees and their families informed all year, including at [Kalos Services](https://ethosbenefits.com/results/kalos-services), where the internal advocacy program is called Care Coach.

- **Provider access.** How member-nominated providers and early outreach keep doctors in reach on a [self-funded health plan](https://ethosbenefits.com/benefits-101/self-funded-health-insurance).
- **Balance bills.** What a balance bill is, how often it happens on carrier plans, and what a [reference-based pricing plan](https://ethosbenefits.com/benefits-101/reference-based-pricing) vendor should do when one arrives.
- **Choosing a fair vendor.** Why the spectrum runs from aggressive to paying whatever is billed, and what to ask when you [vet benefits vendors](https://ethosbenefits.com/insights/how-to-vet-benefits-vendors).
- **When the broker pushes back.** Why some brokers sell against reference-based pricing, and how [broker compensation disclosure](https://ethosbenefits.com/benefits-101/broker-compensation-disclosure) shows what an advisor gains from a plan.
- **Year-round communication.** Targeted texts, spouse and dependent opt-ins, and quarterly updates, the work behind [employee communications](https://ethosbenefits.com/services/employee-communications).

## About the guest.

Danielle Young of ClaimDoc wrote reference-based pricing plans for 15 years as a benefits broker before joining ClaimDoc, and she says one race team she placed on reference-based pricing has kept a 0% increase for years. She teaches continuing education on reference-based pricing for licensed insurance professionals and invites employers to contact her on LinkedIn with questions, even if they never buy from ClaimDoc.

## Guests

- **Danielle Young**, ClaimDoc. Danielle Young wrote reference-based pricing plans for 15 years as a benefits broker, including in Indianapolis, before joining ClaimDoc. She teaches continuing education on reference-based pricing for licensed insurance professionals and describes her work as educating reference-based pricing buyers.

## Related guides

- [What is reference-based pricing?](https://ethosbenefits.com/benefits-101/reference-based-pricing)
- [How does self-funded health insurance work?](https://ethosbenefits.com/benefits-101/self-funded-health-insurance)
- [Broker compensation disclosure](https://ethosbenefits.com/benefits-101/broker-compensation-disclosure)
- [How to vet benefits vendors](https://ethosbenefits.com/insights/how-to-vet-benefits-vendors)

## Frequently asked questions

### Will my doctor accept a reference-based pricing plan?

Most providers do, according to Danielle Young, who says ClaimDoc has 96.4% provider acceptance nationally. Chelsea Ryckis says acceptance in the groups Ethos Benefits has with ClaimDoc is about 97 to 98%, and that the providers who decline are often chiropractors and homeopathic providers.

### What is a balance bill?

A balance bill is when a provider decides the plan's payment was inadequate and bills the member directly for the difference. Danielle Young describes a hospital that receives the employer plan's payment for a knee surgery, rejects it, and goes around the plan to tell the member they owe the rest.

### Are balance bills more common with reference-based pricing?

Historically yes, but Danielle Young says a good vendor changes that. She says balance bills already happen on about 8% of claims on major carrier plans, that ClaimDoc's balance bill rate is less than 1% nationally, and she calls balance billing fears a scare tactic when the plan works with a judicious partner.

### What should an employee do after getting a balance bill on a reference-based pricing plan?

Open the mail and report the bill right away. Danielle Young says ClaimDoc contacts the provider after the first balance bill it knows about and works to settle it, and that it works with state attorneys general to reverse credit impairments. She adds that impairing someone's credit because of a medical bill has been illegal for many years.

### How should an employer prepare employees before switching to reference-based pricing?

Start before open enrollment. Chelsea Ryckis recommends asking employees which providers they want accepted so the vendor can reach them first, and Danielle Young says ClaimDoc begins that outreach 60 days before the effective date. Young also recommends communication no less than 60 days before the plan year and at least quarterly after.

### What if my broker says reference-based pricing doesn't work?

Challenge the broker, and consider interviewing others. Danielle Young says a broker who pushes back without having written reference-based pricing is committing what she calls an immediately fireable offense, while one who says let's investigate is a good partner. Chelsea Ryckis says a broker without that experience should work hand in hand with a team that can take on the bulk of the work.

### What does it mean when a reference-based pricing vendor is a co-fiduciary?

Danielle Young says ClaimDoc comes on as the self-funded employer's co-fiduciary, which she explains means that if the employer is sued over the plan, ClaimDoc is sued too. Chelsea Ryckis says these protections for employees go further than a traditional carrier plan, where she says employees have none.

## Full transcript

[00:01] Welcome, welcome to The Business of Benefits. The Business of Benefits is your no-BS, no-sales guide to real solutions. No gimmicks, just the truth about how to take control, transform your benefits, and care for your most valuable asset, your people. If you're tired of the same old sales pitch and you're ready to rethink your benefits, this podcast is for you. The truth is out there. Are you ready to hear it?

[00:01] Chelsea Ryckis: Hey everybody, welcome to The Business of Benefits. I'm your host, Chelsea Ryckis. Today we've got Part 2, which is all about the employee experience. So those fear tactics that maybe you've been hearing, what are they actually like in real life? So check it out. Let us know what you think.

[00:28] Chelsea Ryckis: So other things that we've covered: the financials pretty well, feasibility. The dual option, I think, was a really great thing for us to cover for employers. Is there anything else before we really focus on what goes wrong? And I say wrong with air quotes again, because it's a smaller problem than the problems you've been facing in the past, having no control over your health plan. But before we dive into challenges, do you have anything else you want to say about reference-based pricing?

[00:57] Danielle Young: I think we can jump into challenges, because I think that's going to be really meaningful for people.

[00:57] Chelsea Ryckis: Yeah, I'd like to start with the typical one that we kind of just explained, which is

[00:57] My doctor doesn't take this.

[00:57] Chelsea Ryckis: Yeah. What is ClaimDoc's general approach to that? And by the way, I will tell you our provider acceptance rate in the groups that we have with you guys is 97, 98%. So there's only, and that's with hundreds, well, no, with all the groups, thousands and thousands of employees, 2% of providers aren't willing to pay our plan. That's not bad, and those providers are probably chiropractors, homeopathic medical providers.

[01:53] Danielle Young: So I'll tell you, for us with ClaimDoc, we have 96.4% acceptance nationally. Okay. Last year we had members nominate providers, meaning that members of our plan asked us to call over 24,000 providers that we did not already have relationships with, and in that exercise, we got over 96% of them that were willing to accept our plan, to send us claims. Part of that is because we pay providers quickly. The other part of it is that we have a provider relations team that's led by a former CEO of a hospital. So he is a hospital administrator by trade, and so he speaks that language, and he also helps keep us humble and understanding how we need to meet hospital systems where they are. Everybody has a P&L, a profit and loss statement. We don't want to be adversarial. And that's why we do have such good success with access. Some of our predecessors, and I kind of alluded to this earlier, some of our predecessors historically have essentially forced their members into facilities, and then when those members subsequently get balance billed, they get sued. Hospital systems end up in court. Members end up in court. That's not our bag. We're not doing that.

[03:15] Chelsea Ryckis: Nobody wants that. And to your point, the adversary thing, I think that's really important to note, because there are, I hate this saying, multiple ways to skin a cat, but there are multiple ways that reference-based pricing can be implemented, and depending on the vendors that you're choosing, some are more aggressive than others, and

[03:15] Also, who's ever skinned a cat? Can we

[03:15] That's why I think the saying is ridiculous. It's like,

[03:43] Can we all just go out skinning cats?

[03:43] Yeah. No, thank you. Cats are great. But I forget what I

[03:43] Sorry, I made you lose your train of my

[03:43] Chelsea Ryckis: No, it's fine. I'm never going to forget this. So let's talk a little bit, then, the adversary comment,

[03:43] The adversarial component.

[03:43] Chelsea Ryckis: And that, I think to make that super clear, it's like you could work with a vendor that's super aggressive and not going to pay, just really, really aggressive, or you could work with somebody that understands that the most important thing is just getting the job done in a fair and reasonable and quick, you know, that's kind of

[04:10] Danielle Young: Quick manner. Yeah. Well, and conversely too. Conversely too, though, so the way we look at it, there's a little bit of a spectrum, right? You don't want to be this hard ass, like, we're only going to pay you 125% of Medicare and that's it, or else we're going to take you to court, and that's it. There's also the other side of the spectrum, which we also don't prescribe to, which is, oh, you want 300% of Medicare, 400%? Okay, well, we're just going to pay that to make it go away, because we don't really want to get into a skirmish with you. And at that point, if you're paying 400% of Medicare, you might as well just hire UHC, because that's it. You know what I mean? You're going to land at the same reimbursement. So I think we do a really good job, and again, I just have to shout out our provider relations team, of driving in the middle, right? We're not going to be these people that want to sue the out of you for not taking our reimbursement, but we also don't want to lay down and be like, we're not going to get walked on. We're not a PPO.

[05:05] Chelsea Ryckis: Yeah, that makes perfect sense. So the next thing that I hear a lot about, so it's access, right? And oh, one thing I wanted to mention about the program that you were talking about, of calling 24,000 providers, preemptively making sure that they will take payment from the plan. The thing that I find really important when we're rolling this out is best practice is to roll out this program before open enrollment, before everybody's using the new plan, and then you have this influx of people who feel like, oh well, my doctors aren't in network, blah, blah, blah. Do this way ahead. It gives you an opportunity to educate employees about what you're doing and why you're doing it, and, hey, help us build out our new network, or however you want to phrase it to them. I know network's a not friendly word necessarily to use with this, but it helps in understanding in those first couple meetings with employees. If you say, you don't have a network, but if you would want us to make sure that your provider will be accepted, we can build that out for you. And I think preemptively doing that is such a game changer for the noise component.

[06:31] Danielle Young: Dude, I'll tell you. So we at ClaimDoc right now, we make 10 outbound phone calls for every one that we get inbound from a provider. So we spend a ton of time and energy meeting the provider community where they are. And that typically, to your point, we start 60 days prior to the open enrollment effective date. That's when we start that pave the way process. We always prioritize people with actual appointment dates. So for example, if someone's going to give birth a month after the plan goes live, then we're going to start there. And then we kind of funnel down into, this is my kid's pediatrician, this is my allergist. We get to that soon before the effective date, but we prioritize based on timing. But yeah, it's a huge part of our solution. And if you're going to go about doing something this, I hate to use the word disruptive, if you're going to go about reference-based pricing, you have to do the work, right? To our point earlier, you have to do that homework. And also too, just to be clear, we do all of that at ClaimDoc before we ever get paid a dime.

[07:26] Chelsea Ryckis: Yes, that's actually us as well. Because we're also not getting paid until after the plan is implemented with the monthly fee, right? So, you know, if you're working with... That's a really good point. I don't think a lot of employers realize that all this preemptive work prior to renewal, if you are coming on for the first time, that's unpaid work.

[07:53] That's on us,

[07:53] which is on us, but that's a lot of

[07:53] It's, and it's, but I think it's an investment in it. It's believing. It's walking the walk,

[07:53] right? It's totally, it's like, this is the path that we've chosen. This is the business model that we've chosen, and there's pros and there's cons to it, but I believe so wholeheartedly in it that I'll sacrifice if we need to for a few months, just to

[08:20] just to give you the confidence that you need to know that this works, right?

[08:20] Chelsea Ryckis: Yeah, totally. Let's talk balance bills. What is it, and how does it work?

[08:20] Danielle Young: Yeah, so a balance bill, we're all pretty familiar with it if you are a consumer of things even as innocuous as dental insurance. If you pay car insurance, you probably have some idea of this. So a balance bill is essentially when a provider gets a reimbursement from insurance or from the employer plan, and they think it's inadequate. Let's go back to the knee surgery, for example. The employer sends their $40,000 reimbursement, 20, whatever it is, and for some reason or another, the hospital says, nope, that's inadequate. What they often do is they'll go around the employer insurance plan and go straight to the member and say, hey, you owe me X number of dollars, because your benefit plan, your insurance plan didn't pay me that really

[09:16] Didn't cover it.

[09:16] Danielle Young: Yeah. And so that situation happens on network plans too. I always like to clarify that, that UnitedHealthcare, Anthem, Cigna, Aetna, doesn't matter who you have. That already happens about 8% of the time, 8% of claims on major BUCA carriers. When I say BUCA, I'm referring to Blue Cross, United, Humana and Aetna specifically. That's an industry term I just wanted to make sure I defined. But on a BUCA plan, there are still balance bills that happen about 8% of the time on claims. And employees often don't really know better, so they tend to pay them, or they ignore them and they end up in credit impairments and what have you. Reference-based pricing has been historically pretty notorious for creating more balance bills on healthcare plans because of the repayment and the reimbursement structure, which is less than what hospitals would like to see historically. I will say in the more modern RBP times, there are many ways that we work around this. At ClaimDoc, the way we do it is that we work around it because we have a provider relations team. Nationally, our balance bill rate right now is less than 1%. So we do better because of our outreach to providers, because of our consistent commitment to partnerships with healthcare providers all over the country. That's why we see that. But historically, if somebody comes and says, oh, you don't want to do reference-based pricing because of balance bills, that's a scare tactic, is what I call it. Because if you're using a good partner who's being judicious about that, that's not really actually a thing. It's sort of a, it's the boogeyman in the closet of how reference-based pricing works. I will clarify, for ClaimDoc's purposes, we will go after, I say go after, let me rephrase. At ClaimDoc, we contact a provider after the first balance bill, as long as we know about it, right? So employees have to open their mail. If you have a manchild on your employee plan that doesn't open their mail, and they get a balance bill and subsequently a credit impairment, that was going to happen anyway. So I don't know what to tell you about that, right? But as long as we know about a balance bill, we will always intervene immediately and connect with the provider and come to an agreement and get that settled so that it goes away. Something else that we do as well is we'll go connect with state attorneys general to reverse credit impairments if that happens on our watch, right? So even if it was because bro didn't open his mail and now he's got three balance bills and his credit's impaired, we'll still go back and repair that, because it's the right thing to do. And furthermore, it's illegal to impair someone's credit because of a medical bill, and it has been for many years. So balance billing, it is still a talking point, but I love talking about it, because I do think it's important to recognize that these things happen, but I would call that almost more of an open employee benefits concept than an RBP concept.

[12:32] Chelsea Ryckis: If people are getting bills and they're not opening their mail, they're not paying their bills, yeah, they're going to get balance bills, they're going to get credit impairment. That happens anyway. And there's no protections under a traditional BUCA plan. There's not going to be any protections for the employee whatsoever. But if you're working with somebody like ClaimDoc that takes on literally a co-fiduciary status, and I know, I don't know exactly what your policy is, but I know it's far superior in the industry in terms of the protections that you're willing to give employees and how far you'll go to protect them.

[13:00] Danielle Young: Yeah. Yeah. And you use the word co-fiduciary, right? So if you're an employer and you're offering a healthcare plan and you're choosing to self-fund, that means you're going to pay your claims, right? You're subject to ERISA. You're going to essentially take on the role of the insurance company. When you partner with us at ClaimDoc, we come on as your co-fiduciary, which means if you're getting sued because of something, we're getting sued too. And that's an incredible amount of responsibility that we take very seriously. So, you know, we don't have clients that get sued very

[13:27] Chelsea Ryckis: No. No, no, no, no. And in the 10 years that we've been doing this, there's never been anything that got to that point. We've had balance bills, obviously. We calculated it over the span of the last decade, less than 2%, way less. It's 1.5. So right in line with your book of business. And most of them are small. And here's the other thing. If there's a situation, if something blows up, right, and it's a hospital bill, nobody, they're just not willing to negotiate. It's 50 grand, maybe 60. That sucks. But if it's once in a few years, and you have to eat it. Yeah. Just like that. That's how we kind of go through these processes. It's like, how many times did we win, right? If we've been billed 20 million, we've paid six. If we have to pay what we're going to lose once, we're going to lose. And I hope it's

[14:26] A marriage.

[14:26] Yeah. Exactly.

[14:26] It's a marriage, right? There are times where you're going to win, and there are times where you have to clean the litter box, and it is what it is, right?

[14:56] So, yeah, that's totally. Thanks for bringing that up. That's a very valid point for sure.

[14:56] Chelsea Ryckis: Yeah. And yeah, I just find it so interesting, some of the feedback that we hear, or the rebuttals, if you will, of, well, we were told that this. Okay, so we did balance bills, we did access. What else do you hear as a main challenge of reference-based pricing?

[14:56] Danielle Young: You know, I think for the employers listening out there, just to speak directly to the population, I think if you go to your broker and you say, listen, I heard on this podcast about reference-based pricing, and I'm really interested in investigating this, if your broker says to you, no, or it doesn't work here, or something like that, I would challenge them. I would challenge them, and then I would also start to interview other brokers. Because I said this yesterday. I'm actually in Nashville, Tennessee, and yesterday I gave CE, continuing education for licensed insurance professionals in the state of Tennessee, on reference-based pricing. And my closing remarks were the same. I said, if you're out in the market selling against reference-based pricing now in 2025, you're just starting to look ignorant. And so if you're willing to do it, and especially if you've never done it before, right? So if you're an employer that's interested in the savings, you want a really great member experience, ClaimDoc, I know we're the gold standard, and I can say that because I wrote reference-based pricing for 15 years as a broker, and I came to ClaimDoc because I'm so deeply passionate about the depth and breadth of our experience for members and our savings. So if you want to do it, ask the questions of your broker consultant and see what they say. And if they start to act reticent, or they're trying to tell a story or provide a narrative without any actual experience writing it themselves, I would call that an immediately fireable offense. If they're willing to say, I don't know, let's investigate, let's interview a few, great. That means you have a partner that's willing to strategize, learn, listen. That's a good partner. But I think as an employer, you have to look at reference-based pricing as a feasible way to manage healthcare trend. And I'll tell you the biggest success story, I love to tell this story. When I was a broker in Indy, I had a race team, and it was, let's see, I want to say it was 120 people on the plan, and I wrote them on a reference-based pricing plan in 2015, '14 or. And to this day, they have 0% increase.

[17:20] Chelsea Ryckis: None.

[17:20] Danielle Young: Zero.

[17:48] Chelsea Ryckis: That's amazing.

[17:48] Danielle Young: That's on a race team. Okay. So these aren't office people.

[17:48] Chelsea Ryckis: Low risk.

[17:48] Danielle Young: Yeah. This is a high-risk population, and they've maintained, they're not my client anymore because I'm no longer on the broker side, but they've maintained that for several years. And so I think you have to seriously evaluate that type of outcome if you're an employer. And if you're going to do it, and your broker is being reticent about it, they're pushing back and they're making up horror

[18:18] Red flag, giant red flag.

[18:18] Chelsea Ryckis: The other thing, and you made a comment about, maybe your broker isn't super familiar with these strategies, but they're at least willing to look at it. That's huge.

[18:18] Danielle Young: I mean, actually, let me rephrase. I think that's the bare minimum, but

[18:18] Let's just call it as it is. That's, yes, you're doing your job. I have said this so many times. I feel like people in this industry can be incredibly overcompensated for mediocrity.

[18:47] Say it again louder for the people in the back. Rewind and hear it again.

[18:47] Chelsea Ryckis: Right. But I think something that's interesting to point out is, if I was an employer listening to this, I wouldn't really want to do reference-based pricing with a broker partner that hasn't done it before, unless they're going to work hand in hand with somebody like Danielle's team that can really take on the bulk of that work for them. But I will tell you, most of the times when I've seen that it doesn't work, it's because the wrong account management team, like Danielle kind of alluded to earlier. There's conversations that need to be had. There's a finesse. It's just a completely different business model. So consider a co-consulting. We've been approached for that a lot in the last few years. Hey, I love my broker. They're trying to do what's best for me. We feel like we're mostly meeting our fiduciary obligations with them. They're not pulling any wool over our eyes, but they don't know how to do this. Can you teach them? Sure. Or can you teach us? Sure. We charge a fee. We teach you how to do it. You keep your broker. That's fine. It's less about who's doing it and more about it being done right.

[19:41] Danielle Young: Absolutely. Yes. Amen. It's about getting it right the first time, right? That's what I say to people about reference-based pricing. The most important thing is to do it right the first time. I didn't do it right the first time, right? I didn't use ClaimDoc the first time, and that was 15 years ago.

[20:10] We've all got, yeah,

[20:10] everyone who's done it. Everyone who's done RBP has a horror story, for sure.

[20:10] And you learn from it,

[20:10] and then you don't up the same way.

[20:10] You don't around. You found out, and then you readjusted, and then you got a better partner, and yeah, totally.

[20:37] Danielle Young: And I think too, something that's important for the employer community to hear is that the average age of a group insurance broker consultant is 59.

[20:37] Chelsea Ryckis: That's terrifying.

[20:37] Danielle Young: Average. Okay, we're not talking about top end here, okay? The average is 59. And reference-based pricing, in its modern context, is only about 15 years old, maybe 20, right? So of course the community is a little slow to roll it out, right? Of course there's going to be this reticence, this stubbornness about it. Of course they're going to sell against it, because for the last 59 years, whatever, how many years they've been selling fully insured products and making a boatload of money with very little work.

[21:05] Chelsea Ryckis: Exactly. It's so nice to hear other people say these things, because when you are one yourself that's doing it differently, nonetheless, I don't love the look of it, but for someone in your position to be able to call it out that way, I hope it lands even more with employers.

[21:33] Danielle Young: Yeah. Yeah. I mean, we're reaching a turning point, and this is another, sorry, it's not Sunday, but here's a sermon for you. Another thing that I think is really important for employers to hear is that the number one lobby in American politics is healthcare, right? We spend more as a country on lobbying for healthcare than any other lobby, period. That includes pharmaceuticals, by the way, so that incorporates a large chunk of it. But we haven't seen any significant betterment, progress through legislation since the creation of Medicare and Medicaid. Now, I will say the ACA was a good swipe. Well, the ACA and CAA, both very important pieces of legislation. ACA, Affordable Care Act, Obamacare, 2010, and then the CAA after COVID under the Trump administration, the Consolidated Appropriations Act. Those are both very important pieces of legislation that are bettering our community. But really, what's going to change the tide is employer plans.

[22:56] For sure. The power sits in the employer plan. The employer-sponsored healthcare plan space is how we're going to change the way that the middle-class American experiences healthcare in this country.

[22:56] Chelsea Ryckis: One employer at a time. That's it.

[22:56] Danielle Young: One employer at a time. And all we have to do is collect them, right? We have to collect enough employers with enough collective gravity to really change it. But that's something that we're really passionate about here at ClaimDoc, making sure that we are continuing to collect the type of employer that understands that the responsibility lies in their hands. It's not going to happen with the government's change. It's not personal responsibility change. It's like recycling, right? We can recycle, but until the big guys recycle,

[23:51] Chelsea Ryckis: Doesn't matter.

[23:51] Danielle Young: It doesn't really matter, right? It's a drop in the bucket. So I think the employers really hold the power, and I encourage them to harness that, because I think that's going to be the real impetus of change in our

[23:51] Chelsea Ryckis: 100%. I'm going to split this show up into two episodes, and the first part will be what is RBP, and then the second part is going to be member. No, why are you sorry? No, this is perfect. I'm so glad. What I want to do is, do you want to add anything to the first part or the second part, and then we can close out?

[24:20] Danielle Young: I don't think so. Unless you think there's something that's been left unaddressed.

[24:20] Chelsea Ryckis: I think the only thing maybe we should chat about is, and I know this isn't necessarily on your end, it's more maybe on the consultant end, but the importance of ongoing communication, and how often that's overlooked. Do you have any comments from your perspective on that?

[24:47] Danielle Young: Yeah, so of course, when you're going to implement something like reference-based pricing, there has to be a good lead time to make sure that there's adequate planning, strategizing, and every employee population is different, right? So you as the employer understand whether your people get more value out of a flyer in the breakroom versus a text, or versus the internal internet or whatever. So there has to be some strategy that's really thought through around how do we reach people. But that should certainly start no less than 60 days before the plan year. I say 60 days because that's also where that coincides with our pave the way process at ClaimDoc. But furthermore, we like to see quarterly communications with employees. We all know, you and I know, Chelsea, because we've both been on the advisor side, but we know that 20% of employees incur 80% of the claims, right? So that 20% is going to get engaged early and often. But that leaves the other 80%. What happens when Bobby goes and breaks his arm playing baseball on Saturday, right? What happens when Carol gets a cancer diagnosis no one expects, right? What happens then is, ideally, they've communicated, or they've heard at least a little bit, right, from their benefits consultant, from their employer, from their ClaimDoc member advocate, and they know what to do, right? People don't learn and retain information about their employee benefits program because it's yucky. It sucks. It gets 8% more expensive every year. No one knows how it works. So people avoid it because it's

[26:40] Until they have to engage. Yes.

[26:40] Chelsea Ryckis: So something we do, and I love that, I think quarterly makes a lot of sense at the very least, especially if it's something that ClaimDoc is kind of spearheading, right, as a vendor. But I think advisers, and employers, hold your advisers to this. Remember, employers, what Danielle just said: you have all the control. You control how much your advisers make. Even if they tell you otherwise, you control everything. The power is in your hands. But nonetheless, we will do two communications a month, targeted. One will be reference-based pricing, and it's only going to go to those that are in the reference-based pricing plan. And it might be how to handle provider objections, or it might be, did you get a bill? You want us to review it? We brand. And then the other text will be something about other benefits, like file your wellness benefits on your accident plan, something more fluffy and easy, because you can't just hit them with serious stuff all the time, or dental cleaning reminders, stuff like that, right? Fluffy. Yeah, exactly. But what's really interesting is when you send those messages out, if you have a good marketing team that knows how to craft engaging subject lines, they can make cool graphics so it's not just boring insurance, but it's actually engaging. They're going to open it. And then you include dependents. So the very first text message that we send out before open enrollment is, is your spouse going to be involved in your benefit decisions this year, or your dependent? If so, respond with their name and their number, and they can get communications. They can enroll, and you don't have to fight about it. Yeah. And they love that. So then we have all the dependents. After open enrollment, we see who's been enrolled, who's not. We take them off of the list, obviously, and then we hit them with this information throughout the year too. So when it's their time of need, they literally open up their text messages, and they already have been talking to us. Maybe they didn't respond, but we've been talking to them twice a month for 12 months. So they will be like, hey, I need an OB/GYN appointment. Hey, I just got this scary diagnosis, can somebody help me? If you check out, we brand this program too, to clients. So for the one that I'm speaking on stage with next week, a ClaimDoc client, they're called Kalos Services. Their advocacy, internal advocacy, like Ethos program, is called Care Coach, and it has spread like wildfire over the last two years through the company, that if you need anything, you just call the Care Coach, and they love it. And if you look at our Google reviews, there's employees talking about Care Coach as if it's this real thing. I mean, it is, but it is a thing we made up, and it works really, really well. So those are the types of things where it's like, you

[29:28] A lot of people think that when you're an adviser, a broker, consultant, you bring in quotes or you bring in proposals. That is not the case. I firmly believe 90% of what we do is strategic communications.

[29:28] Especially when you're doing reference-based pricing, but a structured

[29:28] communications plan. If twice a month seems too hefty for your population, sometimes we go down to once a month. And again, it's targeted. Not everybody's getting it if they're not in the certain plans. But it's so proactive, especially when you have direct primary care with reference-based pricing. That's a whole other

[29:57] We love DPC. We love

[29:57] I figured you

[29:57] Danielle Young: Yeah. Yeah. We have it on our own plan. All of our employees, I'm on the ClaimDoc plan. We practice what we preach, right? And I do want to ask you, before we get done, I want to know more about this text campaign, because I think we really need to integrate that into how we communicate. And another thing I also wanted to clarify too, I don't know if I mentioned this earlier or not, is that we will also partner with your consultant to train their account staff.

[30:27] Chelsea Ryckis: Cool. That's amazing.

[30:27] Danielle Young: We're piloting that program. Yeah, we're working on building that out.

[30:27] Chelsea Ryckis: Well, that's so good. That's exactly what the brokerages need that don't understand this stuff. That's

[30:54] Danielle Young: I mean, in reality, they should just hire a firm like yours, like Ethos, so that they already have people that know how to do it. But because the broker community is aging so quickly, and the account staff that supports them tend to be newer to the industry or only have exclusively fully insured experience, I felt really passionately that we need to educate in a better way. So we started piloting that too. But yeah, I think communication is, it is everything.

[31:22] That's the crux to whether your reference-based pricing plan will be successful or not.

[31:22] Chelsea Ryckis: We've literally been hired just to create communication plans for employers that are doing reference-based pricing.

[31:22] Danielle Young: Are you serious? You became a communications company on top of a

[31:22] Chelsea Ryckis: I know. I mean, it's not my ideal working relationship. I'd prefer to just manage and measure and kick ass at the whole thing. But if that's the only place, usually it's my brother's the broker, or it's something like that, where it's a relationship that, it's tangential, sort of. Yeah. Which, if we're talking about fiduciary obligation, that's a whole other conversation, and that's not a good enough reason to have somebody on your team, but I digress. All right. This was so fun. Where can our listeners learn more about ClaimDoc and more about

[32:22] Danielle Young: Oh my gosh. Yeah. No, this was a blast. Thank you so much. So much respect for what you guys are doing down there. So you can check out our website. It's claim, C-L-A-I-M-doc.com. Danielle Young, I'm on LinkedIn. If you go on LinkedIn and search Danielle Young, my tagline is RBP. I like to educate RBP buyers, and I mean that. I really do think, if you're an employer and you want to look at this, you have to know what questions to ask, and you really need to dig in. And don't treat it like buying a car. Treat it like buying a, you really need to get into it. And I'm happy to help, even if you don't buy from us. I'm kind of of the attitude, and maybe I'm different than some of our competitors, or some of my compatriots even at ClaimDoc, because we're competitive here, but my attitude is a rising tide raises all the ships, right? So every successful reference-based pricing case, even if it's not with us, is the success for the employer, the employee, and for American healthcare and the status in general. So even if you're not comfortable buying from us or whatever, I don't care. Call me, text me, get with me on LinkedIn. I'm happy to answer questions.

[33:19] Chelsea Ryckis: Speaking my language. The greatest gift that I think we can give with the work that we do is through these types of moments of just pure, you know, and eventually that builds up enough trust to warrant the roles that we're in now and the success that we've had, but it comes first and foremost from a desire to lift others and educate. So, couldn't agree more. Thank you again for being on the show, and yeah, we'll have to have you back, because clearly you and I can talk.