According to Kaiser Health News, May 13, 2105:

 "A small benefits consulting firm called ELAP Services is causing commotion by suggesting an alternative: Refuse to pay. When hospitals send invoices with charges that seem to bear no relationship to their costs, the Pennsylvania firm tells its clients (generally medium-sized employers) to just say no."

"Instead, employers pay hospitals a much lower amount for their services — based on ELAP’s analysis of what is reasonable after analyzing the hospitals’ own financial filings."

Needless to say, this approach is disrupting the conventional approach to hospital payments.

In this approach, employers and their TPAs don't have contractual arrangements with hospitals and employees are free to go to any hospital. In other words, there are no pre-defined networks or PPO-type arrangements. According to Kaiser Health News, "Employers detail the reimbursement process in documents establishing how the plan covers workers. That gives it legal weight, ELAP has argued in court. ELAP agrees to handle all hospital bills for an employer and defend workers from collections in return for a percentage fee tied to total hospital charges."

Click here to read the article.